Ilizarov微创牵伸技术治疗青少年创伤性假性马德龙畸形

Minimally invasive distraction using Ilizarov technique to correct posttraumatic pseudo.Madelung de-formity in adolescents

目的探讨应用Ilizarov微创牵伸技术治疗青少年创伤性假性马德龙畸形的疗效。方法回顾性分析2009年10月至2013年12月收治的7例青少年因创伤致桡骨远端骺板闭合引起的假性马德龙畸形患者资料，男4例，女3例；年龄12—16岁，平均14．5岁；右侧5例，左侧2例；受伤至就诊时间为2～5年，平均2．5年。前臂较对侧短缩1．8—4．0cm，平均3．0cm。7例患者均安装Ilizarov环形外固定支架，并于桡骨远端微创截骨，根据术前测量掌倾角及尺偏角的丢失，调整桡骨远端位置，以尽量恢复掌倾角及尺偏角的角度，将腕关节置于功能位，继而牵伸治疗。术后7d开始行牵伸滑移，速度为1mm／d，分4—6次完成。末次随访时按Gartland．Werley腕关节评分标准评定疗效。结果7例患者术后获12～48个月（平均30．0个月）随访。平均延长长度为3．2cm（2．0～4．2cm），外固定支架带架时间平均为4．5个月（3～7个月），平均愈合指数为30．0d／cm（22～40d／cm）。下尺桡关节复位良好，关节稳定，桡骨短缩畸形均得到矫正，双侧肢体长度接近等长。末次随访时患侧掌倾角、尺偏角、腕关节活动范围及前臂旋转功能均较术前明显改善，差异均有统计学意义（P〈0．05）。所有患者术后无针道感染及血管、神经损伤等并发症发生，延长骨段均获骨性愈合。末次随访时按Gart—land—Werley腕关节评分标准评定疗效：优3例，良3例，中1例。结论Ilizarov微创牵伸技术治疗青少年创伤性假性马德龙畸形安全、可靠，损伤小，不遗留明显瘢痕，并发症少，临床效果满意。

Objective To evaluate the minimally invasive distraction using Ilizarov technique to correct posttraumatic pseudo-Madelung deformity in adolescents. Methods Seven patients with pseudo- Madelung deformity caused by premature closure of the distal epiphyseal plate of the radius after their traumas were treated in our department between October 2009 and December 2013. They were 4 males and 3 females, with an average age of 14. 5 years （range, from 12 to 16 years）. The right forearm was affected in 5 cases and the left in the other 2. Every patient had a clear history of trauma, and the interval between injury and surgery varied from 2 to 5 years （mean, 2.5 years）. The affected forearm was averagely 3.0 cm （range, from 1.8 to 4.0 cm） shorter than the contralateral healthy one. Circular Ilizarov external fixators were installed and minimally invasive osteotomy was performed at the distal radius. According to the preoperative loss, the distal radius was adjusted to restore the palmar tilt and radial inclination as much as possible and the wrist was placed in functional position. Modulation of the external apparatus began 7 days postoperatively at a rate of 1 mm/day, which was divided equally into 4 to 6 times. Outcomes were evaluated at the last follow-up according to the Gartland-Werley criteria for the wrist function. Results The follow-ups ranged from 12 to 48 months （mean, 30 months）. The average length of distraction was 3.2 cm （range, from 2.0 to 4.2 cm）. The external fixator was in place for 3 to 7 months（mean, 4. 5 months）. The mean healing index was 30 d/cm （range, from 22 to 40 d/cm）. The inferior radio-ulnar joint achieved complete and stable articular reduction. The affected forearms were equal to the contralateral ones in length. Radiologic parameters （plamar tilt, radial inclination, and radial length） and physical functions （range of motion of the wrist joint and forearm rotation） improved significantly after surgery. No pin site infection or neurovascular injury was recorded and all the lengthened bone segments achieved complete bone union. According to the Garttand-Werley scoring system, 3 cases were excellent, 3 good, and one fair. Conclusion The minimally invasive distraction using Ilizarov technique is a reliable and effective treatment of posttraumatic pseudo-Madelung deformity in adolescents, leading to limited comphcations and satisfying clinical outcomes.