Ilizarov支架在小儿下肢短缩合并成角畸形矫正中的应用

Angulation and shortening deformity correction of lower-limb with an Ilizarov apparatus in children

目的探讨Ilizarov支架矫正儿童下肢成角伴短缩畸形安全性与可行性。方法应用矫形外科原则,对2004年8月～2008年7月收治的8例儿童下肢成角伴短缩畸形病例采用Ilizarov支架一期手术、渐进矫形方法治疗。术前测量患肢短缩和成角畸形的程度并确定成角旋转中心的位置。术中支架铰链安置在成角旋转中心水平。术后7 d开始通过调整支架螺杆,逐步同时矫正成角和短缩畸形。随访观察肢体长度、畸形有无复发、关节活动范围、肌力;X线片观察下肢力线、关节水平线与机械轴线角度以及新生骨塑形情况。结果 8例患儿中6例利用微创截骨部位完成矫形与延长,2例于骨折畸形愈合部位截骨矫形、临近骨段延长。术后平均矫正成角畸形33°,平均延长5.2 cm。所有病例下肢机械力线恢复,相关关节角度恢复至正常范围,双下肢等长。最后随访时X线片显示延长骨痂愈合良好,无再骨折。无神经血管损伤发生。结论 Ilizarov支架矫正儿童下肢成角伴短缩畸形是安全可行的,能精确恢复下肢长度与力线,手术并发症少,矫形效果好,避免了多次手术,不足之处在于支架治疗时间长。

Objective To evaluate the security and feasibility of angulation and shortening deformity correction of low- er-limb with an Ilizarov apparatus. Methods From October 2004 to July 2008, 8 children with the angulation and shorten- ing deformity of the lower extremity were treated with Ilizarov apparatus gradually during one stage. The extent of shortening and angulation deformity were measured and the center of rotation of angulation （CORA） was identified before operation. The hinges of the Ilizarov apparatus were placed at the level of CORA. The apparatus were adjusted to correct the angula- tion and shortening defornlity simutaneously 7 days after operation. During follow-up, the leg length and range of motion were recorded clinically, the mechanical axis and articular angle as well as the remolding of the new bone were observed ra- diographically. Results The angulation was corrected at the deformity site and bone lengthening was performed at the ad- jacent segment in 2 cases, 6 cases completed the deformity correction at the osteotomy site. The extent of angulation correc- tion averaged 33~ and bone elongation averaged 5.2 cm. The mechanical axis was realigned in all cases, articular angle was within the normal range and the leg length was equal. X-ray film at the latest follow-up showed good healing of the newborn bone, no fracture was observed. There were no blood vessel and nerve injury in all cases. Conclusions Angulation and shortening deformity correction of lower-limb with an Ilizarov apparatus is safe and feasible. But the time of therapy is long.