双下肢同步延长术治疗软骨发育不全性侏儒症

BilateralLengtheningoftheLowerLimbsfortheTreatmentofAchondroplasia

双下肢延长术治疗软骨发育不全性侏儒患者是近年来开展的一项新的手术方法．从１９８４年６月～１９９２年１２月，我们采用自行设制的框式外固定架为３８例患者施行了双下肢延长术．其中男１７例，女２１例．年龄９～２１岁，平均１６岁．术前身高１０６～１４０ｃｍ，平均１２４ｃｍ．采用三种术式：下肢骨骺牵开１４例（２８个节段），胫骨干骺端截骨延长２０例（４０个节段），股骨转子下截骨延长４例（８个节段）．术后胫骨延长长度为４．５～２２ｃｍ，平均１４．５ｃｍ，延长率为原骨长度的２５％～１４７％，平均７５％．骨愈合时间１５０～４２１天，其中３２例平均１５３天获骨愈合．股骨延长９～１６ｃｍ，平均１２ｃｍ，延长率３２％～１２０％．骨愈合时间１４０～３９１天，平均２２０天．平均治疗时间３９１天（１８０～５７１天）．愈合指数：胫骨３２ｄ／ｃｍ，股骨３８ｄ／ｃｍ．并发症包括足下垂畸形８例（１６足），骨迟缓愈合１例．

Bilaterallengtheningofthelowerlimbsforpatientswithachondroplasiaisanewlydevel-opedtechniqueinorthopaedicsurgery.Theauthorshaddesignedanexternalfixationapparatusandcar-riedoutbilaterallengtheningofthelowerlimbsin38patientswithachondroplasiabetweenJune1984andDecember1992.Therewere17malesand21femaleswiththeagerangedfrom9to21years.Preopera-tively,themeasurementoftheheightswasbetween106cmand140cmwithanaverageof124cm.Thelimblengtheningwasdonewiththreekindsofmethods:epiphysealdistractionon14patients(28limbs),proximalmetaphysealosteotomyon20patients(40limbs)andlengtheningbyfemoralsubtrochantericosteotomyon4patients(8limbs).Thetibiallengthwereincreasedpostoperativelyfromaminimumof4.5cmtoamaximunof22cm,withanaverageof14.5cm.Theratiobetweenthegainedlengthofthetibiatotheoriginalwasfromaminimumof25%toamaximumof147%,withanaverageof75%.Bonyunionoccurredin150to421daysin32patients,withanaverageof153days.Thelengthofthefemurwasincreasedfromaminimumof9cmtoamaximumof16cm,withanaverageof12cm.Theratiobe-tweenthegainedlengthofthefemurtotheoriginalwasfromaminimumof32%toamaximumof120%.Bonyunionoccurredin140to391days,220days(ranged180to571days).Thecureindex(thetotaltreatmentperiod/lengthobtained)was32days/cmforthetibiaand38days/cmforthefemur.Onecasehadthecomplicationofdelayedunion.