外固定支架延长、矫形结合接骨板治疗股骨短缩并成角畸形

Medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity

目的介绍并总结使用外固定支架延长、矫正成角畸形后从大腿内侧置入接骨板、拆除外固定支架治疗股骨成角和短缩畸形的方法和疗效。方法回顾性研究2009年12月至2016年11月北京积水潭医院创伤骨科收治的12例股骨短缩或合并成角畸形患者资料，男3例，女9例；年龄14～32岁，平均23岁；左侧4例，右侧8例；11例患者幼年时因外伤致股骨远端骨骺损伤继发肢体短缩畸形或合并膝关节内、外翻畸形，1例患者股骨髁上骨折后选择保守治疗致股骨短缩并内翻畸形；股骨短缩3～11cm（平均6．7cm），膝关节内或外翻畸形8°～18°（平均12°）。在股骨外侧安放单边外固定支架，骨干部截骨后7-14d开始延长肢体；待延长到预计长度后对膝部有内、外翻的患者再次于股骨髁上行截骨术，借助外固定支架矫正畸形。采取大腿内侧人路用微创技术置入接骨板并以螺钉固定，拆除外固定支架。记录钢板取出时间、延长情况、膝内或外翻畸形矫正情况。结果术后对9例未取出接骨板的患者平均随访31个月（23-43个月），对3例取出接骨板的患者随访到取出接骨板术后2～14个月（平均6．5个月）。术后无输血。延长均达到预定长度3～9cm（平均6．2cm），新生骨成骨好，膝内或外翻畸形均得到矫正，膝关节屈曲范围仅1例较术前减少40°，其余与术前一致。外固定支架固定时间46-113d（平均91d）。外固定支架指数22d／cm。患者均对治疗表示满意。结论外固定支架临时延长、矫形结合接骨板固定是治疗股骨短缩并成角畸形的一种有效方法，明显地缩短外固定支架使用时间。

Objective To evaluate the medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity. Methods A retrospective study was conducted involving 12 patients who had been referred to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2009 to November 2016 for limb length dis-crepancy and/or angular deformity. They were 3 males and 9 females, with an average age of 23 years （from 14 to 32 years）. Altogether 4 left and 8 right sides were involved. Of them, 11 got their length discrepancy and/ or angular deformity secondary to injury to distal femoral epiphyseal plate caused by trauma in their childhood and one had length discrepancy and angular deformity following unsuccessful conservative treatment of superior condylar fracture of the femur. The femoral shortening ranged from 3 to 11 cm （average, 6. 7 cm）, and the varus or valgus deformity of the knee ranged from 8° to 18° （average, 12°）. First, a monolateral fixator was installed on the lateral femur. The limb was lengthened from 7 to 14 days after diaphysis osteotomy. Femoral supracondylar osteotomy was conducted again in patients with knee angular deformity after the lengthening reached the expected length and the deformity was corrected with the aid of external fixator. After medial submuscular plating via the femoral lateral approach using minimally invasive techniques, the external frames were removed. The time for plate removal, limb lengthening and correction of the varus or valgus deformity were documented. Results The mean follow-up was 31 months （from 23 to 43 months） for the 9 patients who had their plates still in situ, and 6. 5 months （from 2 to 14 months） for the 3 patients who had subse-quently their plates removed. None had blood transfusion. All underwent distraction osteogenesis of the femur to their preoperatively expected length, ranging from 3 to 9 cm （mean, 6. 2 cm）. Both varus and valgus de- formities were corrected. None developed a deep infection. The range of motion of the knee joint was similar to that before operation in all but one patient who had a range of motion 40° less than the pre-operative one. The time for external fixation averaged 91 days （from 46 to 113 days）, with an external index of 22 d/cm. All patients were satisfied with their outcomes. Conclusion Medial femoral submuscular plating after limb lengthening and angular deformity correction with the external fixator on the lateral side is a useful technique for patients with femoral limb length discrepancy and/or angular deformity, significantly shortening the time for external fixation.