可调组合式下肢外固定支架的改良及临床应用

Clinical application of the improved Ilizarov＇s external circular fixator in correction of lower limb deformity

目的介绍自制可调组合式下肢畸形外固定支架系列构型，探讨该装置的临床应用原则。方法在Ilizarov环形外固定支架的基础上，根据国人下肢畸形矫正与重建的需要及便于医生穿针安装操作的要求，将组合式外固定支架的配件与Ilizarov环形外固定支架结合，加入弹簧牵伸装置与螺纹半针固定技术，研制了管状骨微创截骨矫形的工具，并根据下肢残缺畸形的特点，术前预先设计组装好个体化矫形器械。自2004年1月至2010年12月，应用改良Ilizarov外固定矫形器治疗下肢畸形患者146例，男95例，女51例；年龄3．6～61．0岁，平均33．4岁；髋部畸形18例，膝关节屈曲畸形49例，膝关节周围股骨外翻畸形10例，胫骨内翻畸形46例，胫骨骨缺损、骨不连伴复合畸形23例。结果患者术后获8～46个月（平均28．6个月）随访。139例下肢畸形获得矫正、下肢力线基本恢复，行走功能明显提高。1例患者术后截骨端出现位移，重新调整外固定支架后纠正；2例膝关常周围内外翻畸形尚残留10°～15°内翻；3例在骨延长过程中出现膝关节屈曲功能障碍。4例患者出现术后针道感染。髋部畸形按Harris评分标准：由术前（36．91±3．14）分提高为（86．25±2．26）分；49例膝关节屈膝畸形完全矫正；胫骨骨不连处及新生骨均愈合，功能基本恢复。结论改良的下肢畸形外固定矫形支架具有Ilizarov环形外固定器的主要功能，可满足下肢多数畸形矫正、残缺修复与功能重建的需要，临床应用能达到预期治疗目标，适合在临床中进一步推广。

Objective To report a self-improved Ilizarov＇s external circular fixator which can be used for correction of lower limb deformities. Methods The Ilizarov＇s external circular fixator was improved according to the specific requirements for correction and reconstruction of lower limb deformities in Chinese patients and manipulative convenience for the doctor. We tried to improve the complex, heavy and clumsy Ilizarov＇s external circular fixator by designing a set of accessories, including spring traction apparatus, threaded half-pins and minimally invasive osteotomy tubular tools. The whole combined orthotic device could be assembled individually before operation according to the specific characteristics of the lower limb deformity to be treated. From January 2004 through December 2010, the improved fixator was used to treat 146 patients, 95 males and 51 females, aged from 3.6 to 61.0 years （average, 33.4 years）. There were 18 cases of hip deformity, 49 cases of knee flexion deformity, 10 cases of valgus of the distal femur, 46 cases of varus of the proximal tibia, and 23 cases of tibial defect or nonunion combined with other complex deformities. Results The patients were followed up from 8 to 46 months （average, 28.6 months） . Lower limb deformities were corrected, the weight transmission line of the whole lower extremity was restored and walking function was significantly improved in 139 patients. One patient experienced displacement of the distal osteotomized bone which was corrected by adjusting the external fixator. Two patients had residual varus of 10 to 15 degrees after proximal tibial osteotomy. Three patients had malfunction in knee flexion after bone lengthening. Four patients suffered from pin tract infection. By the Harris hip scoring, the mean preoperative score （36.91 ± 3.14） was improved to （86.25 ± 2.26） postoperatively. The knee flexion deformity was completely corrected in all the 49 patients. The tibial nonunion was cured by new bone formation and lower limb function mostly restored in all the 23 patients. Conclusions The improved orthotic device not only retains principal functions of the Ilizarov eircular external fixator but also satisfies needs for correcting various deformities, repairing disabilities and reconstructing functions of the lower limb in Chinese patients. It deserves popularization in clinic.