应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形

Treatment of knee flexion contracture with Ilizarov technology after burns

目的总结应用Ilizarov技术矫正烧伤后膝关节屈曲挛缩畸形的疗效。方法 2012年4月—2017年7月,应用Ilizarov技术治疗14例(17膝)烧伤后膝关节屈曲挛缩畸形患者。男11例(13膝),女3例(4膝);年龄20~48岁,平均37岁。瘢痕形成8个月~24年,平均5年。瘢痕范围上至大腿上段,下至小腿中段,两侧至腘窝内、外侧,均无破溃。瘢痕挛缩后范围为12 cm×10 cm^30 cm×22 cm。术前膝关节活动度(total activity of motion,TAM)为30~115°,平均69°。患者坐轮椅4例,扶双拐行走5例,跛行3例,半蹲行走2例。根据膝关节功能评价标准,术前患者膝关节功能可3膝,差5膝,很差9膝。结果患者均获随访,随访时间6个月~5年,平均2年。无局部皮肤坏死、针道感染、肢端感觉麻木等并发症发生。膝关节屈曲畸形均获得矫正;TAM为70~145°,平均125°。可足底负重行走,患者步态较术前均有所改善。5例术后可不扶拐行走,仅轻度跛行;2例坐轮椅患者术后可扶拐行走。末次随访时根据秦泗河膝关节功能评价标准,优9膝、良5膝、可3膝,较术前显著改善(Z=–3.677,P=0.000)。结论应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形具有微创、安全、操作简便的优点,可获得较好疗效。

Objective To summarize the effectiveness of Ilizarov technique in the correction of flexion contracture deformity of the knee after burn. Methods Between April 2012 and July 2017, Ilizarov technique was used to treat 14 cases（17 knees） of knee flexion contracture patients. There were 11 males（13 knees） and 3 females（4 knees）, with an age of 20-48 years（mean, 37 years）. The duration of scar formation was 8 months to 24 years（mean, 5 years）. The scar ranged from the upper part of the thigh, down to the middle part of the leg, from both sides to the inside and outside of the popliteal fossa, without ulceration. The area after scar contracture was 12 cm×10 cm to 30 cm×22 cm. Preoperative total activity of motion（TAM） was 30-115°（mean, 69°）. There were 4 cases in wheelchair, 5 cases walking with double crutches, 3 cases with limp, and 2 cases with half squat walking. According to the knee function evaluation criteria by QIN Sihe, the preoperative knee function was fair in 3 knees, poor in 5 knees, and very poor in 9 knees. Results All patients were followed up 6 months to 5 years（mean, 2 years）. No local skin necrosis, needle tract infection, limb numbness, and other complications occurred. Knee flexion deformities were all corrected. The postoperative TAM was 70-145°（mean,125°）. All patients were able to walk with plantar weight-bearing, and their gait improved when compared with that before operation. Five cases could walk without a crutch and only slightly claudication after operation. At last follow-up,according to the knee function evaluation criteria, the results were excellent in 9 knees, good in 5 knees, and fair in3 knees, all were significantly improved when compared with that before operation（Z=–3.677, P=0.000）. Conclusion Ilizarov technique has the advantages of minimally invasive, safe, and easy to operate for the treatment of flexion contracture deformity of the knee after burn.