踝上截骨结合计算机辅助六轴外固定器治疗胫骨远端复杂畸形

Supramalleolar osteotomy for complex distal tibial deformity using computer-assisted hexapod frame

背景:计算机辅助六轴外固定器为胫骨远端复杂畸形的处理提供了简便有效的新途径。目的:采用踝上截骨术结合计算机辅助六轴外固定器治疗胫骨远端复杂畸形,并评价其临床疗效。方法:回顾性分析2015年6月至2019年3月采用踝上截骨结合计算机辅助六轴外固定器治疗的18例胫骨远端复杂畸形患者的临床资料,男10例,女8例;手术时年龄15~51岁,平均(26.7±9.1)岁;治疗均为单足(未手术侧无病变或病变轻微)。评价患者手术前后的影像学改变、美国足踝外科协会(AOFAS)评分差异及术后并发症情况。结果:外固定器拆除后随访7~67个月,平均(32.7±18.3)个月。外固定器矫正畸形时间11~65 d,平均(39±17)d;外固定器佩戴时间104~313 d,平均(213±66)d。单纯矢状位畸形2例,单纯冠状位畸形4例,斜面畸形(矢状位合并冠状位畸形)12例。矢状位畸形参数与正常值差值的绝对值从术前的14°±11°,矫正至术后的3°±5°(P=0.002);冠状位畸形参数与正常值差值的绝对值从术前的25°±23°,矫正至术后的6°±11°(P<0.001)。AOFAS评分由术前平均(65.4±15.1)分提高到术后平均(86.4±12.0)分(P<0.001)。有5例患者发生针道感染,所有患者截骨部位均获得骨性愈合并未出现畸形复发。结论:对于胫骨远端复杂畸形,踝上截骨结合计算机辅助六轴外固定器可以有效矫正胫骨远端复杂畸形,改善患肢外观及功能。

Background:Computer-assisted hexapod spatial frame provides a new method to treat complex distal tibial deformity easily and effectively.Objective:To evaluate preliminary clinical outcomes of supramalleolar osteotomy(SMO)followed by computer-assisted hexapod spatial frame correction.Methods:A total of 18 patients(10 males and 8 females)with complex distal tibial deformity were selected for the retrospective study after they had received SMO and frame correction from June2015 to March 2019,with the mean age of(26.7±9.1)years(range,15-51 years).All of them had only one foot treated with the other showing no or slight lesion.Evaluation was performed to pre-and post-operative radiological measurement and American Orthopedic Foot and Ankle Society(AOFAS)Hindfoot score and post-operative complications were also recorded.Results:Patients were followed up for 7-67 months with the mean of(32.7±18.3)months after frame removal.Mean duration of correction was(39±17)days(range,11-65 days)and mean duration in frame was(213±66)days(range,104-313 days).Two patients had sagittal plane deformities,4 patients had coronal plane deformities and 12 patients had oblique plane deformities.The pre-operative parameters of distal tibial joint line were improved from 14°±11°of deviation to 3°±5°of deviation relative to normal value in sagittal plane(P=0.002),and from 25°±23°of deviation to 6°±11°of deviation relative to normal value in coronal plane(P<0.001),while the average AOFAS hindfoot score was improved from 65.4±15.1 to 86.4±12.0(P<0.001).Except for 5 patients experiencing pin site infection,no one suffered non-union or recurrence of deformity.Conclusions:SMO using computer-assisted hexapod spatial frame is an effective method to treat distal tibial deformities,particularly complex deformities,and to improve leg and hindfoot appearance and function.