Ilizarov外固定架治疗痉挛型脑瘫屈膝畸形

Ilizarov external fixator for the treatment of severe genuflex deformity in spastic cerebral palsy patients

目的:探讨应用软组织矫形加用Ilizarov外固定架矫治痉挛型脑瘫屈膝畸形的方法和疗效。方法:依据Ilizarov张力—应力法则及其应用技术,按个体化要求,安装Ilizarov外固定架,在外固定架屈侧设置2个铰链关节便于撑开,伸侧设置1个铰链关节便于加压。术后3～5d,待患者腿部疼痛、麻木感减轻后开始屈侧撑开,伸侧加压,每日屈侧延长2mm左右。定期检查克氏针的张力,以免固定松动。每2周摄X线片复查,根据目测观察膝关节矫正角度及X线表现及时修正延长、矫形方案。患者3～6周后膝关节角度就可完全矫正,在过伸10°位置维持3周,即可拆除Ilizarov外固定架,活动膝关节,然后佩戴下肢伸直位支具行走2～3个月。2例因术前合并股骨下段前弓畸形,Ⅱ期实施股骨髁上截骨术矫正。结果:21例36个膝关节,术前屈膝畸形平均(80.61±25.51)°,矫正后屈曲角度平均(8.91±2.39)°。21例,36个关节平均随访5个月,其中32个关节维持牵伸术后的效果,4个关节屈膝畸形部分复发,平均(9.32±7.33)°。结论:正确使用Ilizarov技术矫治痉挛型脑瘫屈膝畸形,疗效满意,并发症少,是一种微创、安全、有效的治疗方法。

Objective ： To explore the application and efficacy of llizarov external fixator in the treatment of severe genuflex deformity in spastic cerebral palsy patients. Methods：The individualized Ilizarov external fixtor was designed to have two hinges posteriorly and one hinges anteriorly based on the tension-stress law. Distraction posteriorly and simutaneously compression anteriorly started 3 to 5 days after surgery. Extension on the flexion side was 2 mm every day. Check toe movement, wound and wire tension everyday. The deformity were corrected in 3 to 6 weeks. Then the fixator were kept in overextension of about 10° for about 3 weeks before the Ilizarov external fixator were removed. The patients were encourged to start knee rehabilitation program and discharged. And a long leg brace was prescribed to wear while walking for 2 to 3 months. Results：The average genuflex deformity was （80.61 ±25.51 ） ° preoperatively and （8.91 ±2.39）° postoperatively. The patients were followed up for 5 months,21 of which got an excellent results,4 joints had recurrence of the deformity with an average of （9.32±7.33）°. Conclusion： The proper use of Ilizarov technique in the treatment of severe genuflex deformity in spastic cerebral palsy patients could get satisfactory results with few complications.