Ilizarov技术治疗一侧先天性胫骨假关节并严重小腿短小畸形

Clinic investigation of treatment of unilateral congenital pseudarthrosis of tibia and short limb with Ilizarov technique

目的观察用Ilizarov技术治疗一侧先天性胫骨假关节(CPT)并肢体短小的远期临床效果。方法对1例曾经5次手术治疗失败致胫骨严重缺损(9 cm)的患者,彻底清除病变部位病变软组织,保留病变骨段,应用Ilizarov技术在两断端开一凹凸骨槽进行嵌合加压,同时在胫骨近端骨骺下方截骨延长。结果胫骨假关节骨性愈合,骨延长9 cm,延长骨段及假关节段骨完全修复,胫骨远端在未见骨骺线(骨骺破坏)的情况下可观察到长长,随访9 a,患肢胫骨与健肢等长、等大。结论被侵蚀的骨组织(骨段)与纤维瘤病不属一类病变组织,一旦解除骨膜外的纤维瘤病病变软组织的包绕、压迫和侵蚀,病变骨就可复活再生;Ilizarov技术应用灵活,操作精确,适应证广,是治疗CPT及进行骨延长的理想方法。

Objective To study methods for patients with serious damage of tibia （ 9 cm ）, resulting from the treatment failures of congenital pseudarthrosis of tibia （CPT） and short limbs which ever underwent five operations （ allograft of bone, vascularized fibula grafts of normal limbs and operations of external fixation after surgical resection of abnormal tissues）, with the application of Ilizarov technique and its long-term clinic results. Methods The pathologic soft tissues were thoroughly resected in the pathologic part. The pathologic bone end was retained, a concave and convex bone groove was made in the two broken ends with Ilizarov technique to have a compression force and at the same time was lengthened by cutting the bone under the epiphysis in the proximal tibia. Results The pseudarthrosis of tibia healed up with 9 cm lengthening of bone. The lengthened bone and pseudarthrosis were completely restored. The far end of tibia could be observed to grow longer on the condition of unseen epiphysis line （ the damage of epiphysis ）. Patients were followed up for 9 years. The tibias of abnormal and normal bones could grow with the same lengths and sizes. Conclusions The invasive bone tissues （ bone ends ） dont belong to the same pathologic tissues of the fibrcmatosis. The pathologic bones can revive and re-grow once the surrounding, compression and invasion of the fibromatosis outside the periosteum were relieved. Ilizarov technique is used flexibly and is performed accurately with a wide adaptation. It is the ideal choice of CPT and bone lengthening.