Ilizarov技术联合皮瓣即时扩张技术Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形

Ilizarov technique combined with flap instant expansion technique for the treatment of the tibia deformity with skin contracture at one stage

目的：探讨采用Ilizarov技术联合皮瓣即时扩张技术Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形的临床疗效及安全性。方法：自2010年1月至2015年1月,采用Ilizarov外固定技术联合挛缩侧皮肤术中即时扩张技术Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形患者30例,男21例,女9例;年龄25-60岁,平均（40.2±5.5）岁。定期复查X线片,去除Ilizarov外固定后采用美国特种外科医院（HSS）评分标准评定膝关节功能,并采用疼痛视觉模拟评分（VAS）评价其疼痛缓解程度。结果：术后所有患者获随访,时间6-35个月,平均22个月。其中29例患者切口均Ⅰ期愈合,1例患者出现切口感染并发骨髓炎,2例患者并发固定钉松动,扩张皮瓣区均无坏死,无神经血管牵拉损伤症状。术后4-7个月去除外固定架,平均（5.2±1.1）个月。矫正成角角度10°-35°,平均（25.5±3.5）°。术后根据HSS评分标准,总分92.5±6.6,其中优25例,良4例,中1例;VAS评分1.2±1.5。结论：采用Ilizarov技术联合皮瓣即时扩张技术能够Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形,带架时间短,无皮肤坏死及神经症状,能够早期负重锻炼并改善患肢功能。

Objective：To explore the clinical therapeutic effect and safety of application of Ilizarov technique combined with flap instant expansion technique in correcting tibia angular deformity combined with skin contracture by one stage. Methods：From January 2010 to January 2013,30 cases of tibial deformity with skin contracture were corrected by Ilizarov technique combined with flap instant expansion technique at one stage,including 21 males and 9 females with an average age of（40.2±5.5） years ranging from 25 to 60 years. All patients underwent regular reexamination of X ray. After removal of the Ilizarov external fixation,knee joint function were assessed by American Hospital for Special Surgery（HSS） scoring criteria,and the pain was evaluated by visual simulation score（VAS）. Results：All patients were followed up for 6 to 35 months with an average of 22 months. Among them,the incision of 29 patients were primary healing,1 patient had wound infection complicated by osteomyelitis,2 patients complicated with fixed screw loosening,there were no expanded skin flap necrosis and neurovascular injury symptoms. The external fixators were removed at 4 to 7 months after operation with an average of（5.2±1.1） months. Correction angle was 10° to 35° degrees with an average of（25.5±3.5）°. HSS total score was 92.5±6.6 and the result was excellent in 25 cases,good in 4 cases,fair in 1 case; the VAS score was 1.2 ±1.5. Conclusion：The application of Ilizarov technique combined with flap instant expansion technique is a good method for correction of tibial angular deformity with skin contracture by one stage,with a shorter time of external fixation frame,without skin necrosis and neurological symptoms,early load exercise and improve the limb function.