Ilizarov技术治疗小儿疑难四肢畸形的临床分析

Ilizarov technique in correcting complicated deformities of the extremities of children

目的总结应用Ilizarov技术治疗小儿疑难四肢畸形的经验。方法我们于1990-2009年应用Ilizarov技术治疗小儿疑难四肢畸形87例(98肢),其中肱内翻11例(12肢),前臂畸形5例,髋内翻2例,膝内、外翻5例,先天性胫骨假关节24例,严重马蹄足畸形16例(21足),股骨骨折后骨不连3例,股骨髓炎后骨缺损骨不连2例,多发性关节挛缩症膝关节挛缩4例,下肢不等长15例。根据畸形情况制定手术方案,结合有限手术,截骨、穿克氏针,安装Ilizarov外固定器,术后3～7d开始调整外固定器,配合理疗,逐渐负重。0.5～2年拆除伊氏架,配支具维护。结果经1～15年随访,大部分患儿临床疗效满意,畸形矫正,患肢功能改善,无严重术后并发症。结论对一些用传统骨科手术方法难以治疗或无法治疗的小儿疑难四肢畸形,Ilizarov技术可做为首选术式,并获得良好疗效。

Objective To summarize the experience of Ilizarov technique in treating deformities of the extremities in children. Methods From 1990 to 2009,87 children with extremities deformities were operated with Ilizarov technique in combination with limited osteotomy, Kirschner wires fixation and soft tissue operations. The extremities deformities operated including humerus varus for 11 cases, forearm deformity for 5 cases, congenital coxa vara for 2 cases, varus knee for 2 cases, valgusknee for 3 cases, congenital pseudo-arthrosis of the tibia for 24 cases, talipes equinus for 16 cases, nonunion of femoral fractures after treatment for 3 cases, nonunion and bone defect following femoral osteomyelitis for 2 cases, flexion deformity of the knee due to arthrogryposis multiplex congenita for 4 cases, and leg length inequality for 15 cases. Results The follow-up results showed that satisfactory results with improved functions were achieved in all patients without severe complications. Conclusions Ilizarov technique is a simply, minimal-invasive and effective method for managing children with complicated extremities deformities, especially for those difficult or even completely untreatable by traditional procedures. It can be applied as the initial treatment in children with difficult and complicated malformations of the extremities.