改良双侧胫骨延长术的疗效分析

THE THERAPY EFFECT OF IMPROVED BILATERAL TIBIA LENGTHENING

目的 探讨改良双侧胫骨延长术的治疗效果。方法 1997年 5月～ 2 0 0 0年 5月对 32例患者行双侧胫骨延长达到增高目的 ,其中 8例伴膝内翻。手术为胫骨结节下 1.0 cm处骨膜下横形截断胫骨 ,腓骨于外踝上 10 cm水平处横形截断 ,胫骨内置入带锁髓内钉 ,近端上锁 ,小腿外置延长器 ,每日缓慢牵伸延长胫骨 ,达到预期延长目的后 2周拆除延长器 ,同时带锁髓内钉远端上锁 ,延长段骨质完全愈合约 1年后取出带锁髓内钉。结果 32例术后双侧胫骨延长 3.5～ 12 .0 cm,平均 8.5 cm,延长时间为 5 3～ 180天 ,平均 12 8天 ,延长段骨痂生长时间为12 0～ 2 70天 ,平均 180天 ,随访 1～ 3年 ,患者在增高高度、步态及关节活动度等方面满意率达 98%。结论 改良后的双侧胫骨延长术 ,胫骨骨质愈合时间缩短 ,并发症少 ,可同时矫正膝内。

Objective To study the therapy effect of improved bilateral tibia lengthening. Methods From May 1997 to May 2000, 32 patients (varus knee deformity in 8 cases ) with low stature were adopted in this study. Among them, there were 26 females and 6 males, aged from 18 to 45 years old. Operative procedures included: ①tibia osteotomy 1 cm distal from tibia tuberosity and fibula osteotomy 10 cm proximal from lateral malleolus; ②fixation of the tibia osteotomy with interlocking nail and locking the proximal nail; ③fixation of the lengthening apparatus; ④lengthened bilateral tibia 0.7mm per day; ⑤ removed the apparatus and locked the distal nail 2 weeks later after limb lengthening was over. Results The mean distance of lengthening was 8.5 cm (ranged 3.5 to 12.0 cm), the mean duration of lengthening was 128 days( ranged 53 to 180 days), and the mean time of bone union was 180 days (ranged 120 to 270 days). Followed up for 1 to 3 years, 98% patients felt satisfactory in lengthening, gait and joint movement. Conclusion The improved bilateral tibia lengthening technique is recommended for advantage of short time of bone union, less complication and correcting the varus deformity of knee simultaneously.