Ilizarov技术治疗下肢血管瘤致屈膝畸形

Ilizarov technique for treatment of knee flextion-contracture deformity caused by lower limb hemangioma

[目的]探讨Ilizarov技术治疗下肢血管瘤继发屈膝畸形的临床疗效。[方法]回顾性研究2008年7月～2014年5月，共收治血管瘤致屈膝畸形14例，男6例，女8例；年龄12—27岁，平均22岁，合并马蹄足畸形4例。左下肢5例，右下肢9例，病史1—7年。屈膝畸形20°～55°，平均37．4°；被动伸膝后VAS疼痛评分4～10分，平均7．8分。所有患者均单纯实施Ilizarov膝关节外固定牵伸术；伴有跟腱挛缩马蹄足畸形者，同时行经皮跟腱松解术后安装Ilizarov足踝牵伸器。术后5—7d开始牵拉矫正屈膝及踝足畸形，牵伸治疗期间，可以扶双拐下地术肢轻负重行走。[结果]14例患者均获随访，时间6～47个月，平均21个月。所有患者屈膝均矫正，膝关节伸直达0°～5°，平均2．2°，合并马蹄足同期矫正，恢复下肢负重力线。被动伸膝后VAS疼痛评分0—5分，平均3．4分。牵拉矫形时间12～37d，平均17d；治疗期间未出现持续的针孔及牵拉区域出血，5例牵伸区域针孔周围渗血经针道周围无菌纱布加压、口服云南白药及减慢牵伸速度渗血停止。[结论]采用Ilizarov技术缓慢牵拉矫正下肢血管瘤所致的屈膝畸形，无需开放手术切除畸形血管，避免了开放手术引起的出血风险，能够满意一期矫正屈膝畸形及合并的足踝畸形，恢复下肢负重力线和关节活动度的同时能够有效缓解膝关节活动性疼痛，是治疗血管瘤致屈膝畸形的有效方法。

[ Objective] To investigate the clinical effects of Ilizarov technique for the treatment of knee flexion - contrac- ture deformity caused by lower limb hemangioma. [ Methods] A consecutive series of 14 patients with knee flexion - contracture deformity caused by lower limb hemangioma were treated between July 2008 and May 2014. This series included 6 males and 8 females, the age ranged from 12 to 27 years （median age 22 years） . Left knee flexion occurred in 5 cases while other cases were right knee flexion deformity with history for 1 to 7 years. Besides, 4 cases were diagnozed as companied with equinus de- formity. The knee flexion -contraeture deformity was from 20 degree to 55 degree （average 37. 4 degree） and the Visual Ana- logue Scale （VAS） Pain Score after passive knee stretch was 4 to 10 points （average 7.8 points） . All patients received Ilizarov knee joint external fixation surgery and at the same time, if combined with equinus deformity, the foot and ankle joint distraction device had been installed. Distraction for correction began at 5 to 7 days after operation. During the treatment period, the patients were encouraged for light weight walking training. [ Results ] All fourteen patients were followed up for 6 - 47 months （ average 21 months） . All patients＇ knee flexion deformity were corrected to average 2. 2 degrees （range, 0 to 5 degrees）, a normal low- er limb weight line was stored in all the cases. At the final follow - up time point, VAS score was average 3.4 points （ range, 0 to 5 points） . The deformity correction time period ranged from 12 to 37 days （mean, 17 days） . No contineous bleeding in distraction area or pin track was found in the treating period, while 5 transient bleeding arround pinhole of the distraction area were cured with sterile gauze compression, Yunnan Baiyao and slowering of the drawing speed. [ Conclusion ] For knee flexion -contracure deformity caused by lower limb hemangioma, Ilizarov knee joint distraction technique can achieve satisfactory therapeutic effect. This method can restore the lower limb weight line as well as rang of motion of the knee joint, relieve the knee pain and at the same time, avoid the risk of bleeding in open surgery for abnormal vascular resection.