重度创伤性距小腿关节僵直的Ilizarov外固定技术治疗

Ilizarov external fixation technique for severely traumatic stiffness of ankles

目的:探讨应用Ilizarov外固定技术治疗重度创伤性距小腿(踝)关节僵直的方法与疗效。方法:选择2002-08/2004-10在解放军总医院骨科用Ilizarov距小腿关节牵伸器治疗重度创伤性距小腿关节僵直7例,入院前均因创伤在外院接受过各种手术治疗,术后出现严重的距小腿关节跖屈僵直。经平均7个月(5～14个月)的功能锻炼和物理治疗后无明显好转,其中男5例,女2例,年龄16～42岁,平均27岁。手术时先将预先组装好的距小腿关节牵伸器套在小腿与足部,牵伸器的铰链式关节对准距小腿关节的关节间隙,在小腿和足部各穿2组克氏针与牵伸器的钢环固定。术后4d开始调整牵伸杆,直至距小腿关节达到中立位,并在此位置维持4周。带架时间8～14周,平均10周。所有患者术后观察时间为4～24个月,平均10个月。结果:7例患者全部进入结果分析。①距小腿关节平均保持在跖屈3°位置,较术前平均改善43°,距小腿关节活动范围平均为18°,比术前平均进步12°。②除1例需穿矫形鞋行走外,其余6例都能正常行走,步态明显改善,无足踝疼痛。小腿的周径较术前明显增加,外观丰满,肌力增强。③1例患者在牵伸过程中出现屈趾畸形,经肌腱延长手术后消失。无严重并发症,行走功能明显改善。结论:Ilizarov外固定技术治疗重度创伤性距小腿关节僵直,能够避免一次性跟腱延长术可能出现的距小腿关节后部跟腱外的皮肤缺损,组织损伤小与并发症少。

AIM： To evaluate the method and effect of llizarov external fixation technique used in the treatment severely traumatic： stiffness of ankles. METHODS： Seven patients with severely traumatic stiffness of ankles were treated by llizarov retractors in the Department of Orthopaedics, General Hospital of Chinese PLA from August 2002 to October 2004. Having received surgeries due to trauma in other hospitals, all the patients were accompanied by severely traumatic stiffness of ankles at plantar flexion after operation. They could hardly recovered after functional rehabilita tion and physical treatment for a mean period of 7 months（5 to 14 months）. In the 7 patients, 5 were male and 2 female, at the age of 16 to 42 years with the mean of 27 years. The ankle tetras：tots were assembled before surgery and put around legs and feet in the operation. The center of the hinges of Llizarov retractors was made to point the joint space firstly and then two groups of Kirschner wires were fixed, which were passed through legs and feet on the steel rings of the retractors. Distraction was adjusted from fourth postoperative day by rotating the threaded rods. Once the ankle reached the neutral position, the retractor was maintained at this position for four weeks. The distractor was kept on the ankle for 8 to 14 weeks with the average period of 10 weeks. All the patients were observed for 4 to 24 months and 10 months averagely. RESULTS： All patients were analyzed in the result. ①The plantar flexion angle averaged 3 degrees and improved 43 degrees in ankles after opera- tion. The average range of motion of ankle was 18 degrees averagely and improved 12 degrees postoperatively. ②All the patient could walk normally except that one was able to walk assisted by orthopaedic shoes. Their gait was improved remarkably without pain of ankle. Ankle was increased in girth after operation, plum seemingly, and the muscle force was strength- ened. ③Toe flexion deformity appeared in one patient during distraction, and disappeared after tendon extension. No serious complications were found and the walking function improved obviously. CONCLUSION： Ilizarov external retractors can be used to treat severely traumatic stiffness of ankles and have such advantages as avoiding skin damage around tendon on the rear part of ankles caused by one-off tendon- extending operation, limiting tissue damage and decreasing complications.