微创治疗缺血性肌挛缩下肢畸形

Mini-invasive technique for correcting deformities of the lower limb with ischemic contracturc of the leg

[目的]探讨应用微创技术治疗缺血性肌挛缩导致的下肢畸形。[方法]根据Ilizarov技术原理,研制了外固定牵伸器械并应用于治疗。2007年4月~2010年3月治疗31例下肢畸形患者,其中男23例,女8例;平均年龄24岁（3~42岁）,将外固定牵伸器安装于患肢,铰链关节注意对准踝关节间隙,根据畸形情况行少量截骨及软组织松解术,术后5 d开始旋转牵伸杆矫正畸形,根据畸形情况随时变换牵伸杆位置以满足矫正的需要。畸形矫正满意后,患者带架维持矫正位4周,并使患肢参与负重,拆除外固定架后以石膏固定1~2个月。带架时间6~18周,平均9周。[结果]40例均获得随访,平均随访28个月（24~34个月）,全部病例无皮肤坏死、血管损伤等并发症,2例出现针道轻度感染,酒精湿敷后好转;3例负重后踝关节轻度疼痛。[结论]微创牵伸技术对缺血性肌挛缩下肢畸形的矫治疗效满意。

[Objective]To explore the method of minimally invasive technique for correcting deformities of lower limb with ischemic contracture. [Methods]Based on Ilizarov＇s principal,the external fixator distraction apparatus were designed and to treat on deformities of lower limb in 31 patients,including 23 males and 8 females,with an average of 24 years（range 3~42 years）.The distraction apparatus were fixed on the deformity parts of the limb,the center of the hinges of Ilizarov＇s retractors was made to point the ankle joint space.According to the deformity,limited osteotomy in patients,and local soft tissues were probably released.From 5 days after operation,distraction was adjusted by rotation the threaded rods till the ankle was placed in neutral position.When the deformity was corrected satisfactory,the distraction was discontinued and maintained the external fixation for 4 weeks,and the patients could bear weight and walked on the deformed foot.The external fixator was then removed and maintained with plaster for 1~2 months.All patients were corrected by the external fixator from 6 to 18 weeks with an average of 9 weeks.[Results]All the patients were followed up from 24 to 34 months with an average of 28 months.No severe complications,such as necrosis of skin,neurovascular injury occurred in any patient of this group,and 2 cases infected in the incision were cured by alcohol compress treatment and 3 patients felt a little pain when bearing weight.[Conclusion]The method of minimally invasive technique for correcting deformities of lower limb with ischemic contracture by Ilizarov＇s technique can achieve favorable effect.