Ilizarov外固定器矫正膝关节畸形

Correction of knee deformities with llizarov flxator

目的总结Ilizarov外固定器矫正膝关节畸形的临床特点与效果。方法回顾性分析2003年5月至2010年4月，采用Ilizarov外固定器矫正膝关节畸形的21例（22膝）患者资料，男12例，女9例；年龄8-38岁，平均20．3岁。致畸原因：儿麻后遗症4例，烧伤后遗畸形2例，骨髓炎后遗畸形2例，创伤后遗畸形9例，Blount病2例，多发性骨软骨瘤病2例。其中软组织屈曲挛缩5例，采用跨关节铰链Ilizarov支架组合，后侧逐步牵伸矫正；单纯骨性成角畸形8例（9膝）、骨性成角畸形伴骨短缩7例，采用4柱铰链支架组合，先矫正成角畸形，再牵伸延长矫正骨短缩；骨与软组织复合畸形1例，采用以上两种支架的叠加组合。结果21例患者佩戴Ilizarov支架的时间为12-36周，平均22．3周；拆除支架时膝关节畸形均获满意矫正，其中16例（17膝）截骨或骨延长者均获得坚实骨性愈合。所有患者均获伊86个月随访，平均32．1个月。关节活动度由术前的102．14°±49．36°改善为随访时126．90°±24．31°。根据日本骨科协会（JapaneseOrthopaedicAssociation，JOA）膝关节骨关节炎治疗效果判定标准评定患膝功能，术前为（50．24±23．64）分，随访时为（85．71±10．52）分。所有患者随访时均可不扶拐徒手行走，且均可独立生活。2例患膝关节活动度〈90°，不能下蹲。结论Ilizarov外固定器矫正膝关节畸形疗效确切，具有手术创伤小，可随时灵活调整的优点，但也存在与长时间带架相关的缺点。

Objective To explore the clinical characteristics and outcome of correction with Ilizarov fixator for the knee deformities. Methods From May 2003 to April 2010, 21 patients （22 knees） underwent knee deformity correction with Ilizarov fixator, including 12 males and 9 females with an average age of 20.3 years （range, 8-48）. Causes of the deformities included poliomyelitis in 4, burn in 2, osteomyelitis in 2, trau- ma in 9, Blount diseases in 2, and multiple osteochondromatosis in 2. Five patients had fixed flexion con- tracture due to soft tissue, they were corrected through a combination of Ilizarov＇s frame crossover the joint with a pair of hinges by gradual posterior distraction. Eight patients （9 limbs） had one way bony deformities and 7 patients had complex deformations. The frame with 4 hinge-posts was used for correction by restoring the alignment firstly, and then gradual lengthening to correct bone shortening. Additionally, an overlay frame of the above mentioned combinations was applied for correction of bony deformity combined with soft tissue contracture for 1 patient. Results The average time in frame was 22.3 weeks （range, 12-36）. At the time of removing frame, satisfactory alignment was achieved in all of the affected knees, and solid bony healing was obtained in osteotomy or bone lengthening area in 16 patients （17 limbs） with bony correction. All patients were followed up for an average of 32.1 months （range, 6-86）. The range of motion was improved from 102.14°±49.36° preoperatively to 126.90°±24.31° at the final follow-up. Additionally, the Japanese Or- thopaedic Association knee score was also increased from 50.24±23.64 before operation to 85.71±10.52 at the final follow-up. All of them were able to walk without crutches, deal with daily life independently. Only 2 patients with the range of motion of the knee less than 90° were not able to squat. Conclusion Ilizarov fixator has advantages of minimal intervention to local tissue in operation and nimble adjustment at any time, and disadvantages related to a longer time in frame.