Ilizarov技术矫治儿童踝关节骨折后遗内翻畸形

Ilizarov method for treating ankle varus deformity due to epiphyseal injuries

目的探讨Ilizarov技术矫治儿童踝关节骨折后遗内翻畸形的疗效。方法回顾性分析2010年5月至2017年7月在国家康复辅具研究中心附属康复医院治疗的10例踝内翻畸形患者的病历资料,均为14岁以前踝关节外伤后逐渐形成。男6例,女4例,平均年龄17.4岁(10～26岁),左侧2例,右侧8例,6例存在内踝皮肤瘢痕挛缩,4例同时伴患肢短缩。应用CORA方法确定踝内翻畸形成角中心,定制Ilizarov足踝环式外固定架,手术采用微创截骨器行踝上截骨,2例增加跟骨截骨,安装环式外固定架,术后通过调整外固定架逐步矫正踝内翻及合并畸形,2例同时进行肢体延长。采用AOFAS评分标准评估治疗前后功能改善情况。结果 10例患者均获随访,随访时间12～96个月(平均36个月),所有患者伤口愈合顺利,术后3～5天患肢可开始锻炼站立走路,患者及家属对矫形后外观及功能改善表示满意,带架时间平均16周(12～24周),2例矫形同时延长的儿童患者出现一定程度踝内翻复发;AOFAS评分:术前平均40分(30～65分),术后平均85分(75～95分)。结论 Ilizarov技术矫治儿童踝关节骨折后遗内翻畸形具有微创、软组织并发症少灵活可调、可同时矫正合并畸形、可早期负重、有利骨愈合和软组织重建、力线恢复满意等优势,安全有效,值得推广。

Objective To discuss the clinical effects of Ilizarov method for treating ankle varus deformity due to epiphyseal injuries.Methods A total of10patients with ankle varus deformity due to epiphyseal injuries treated in our hospital from May2010to July2017were retrospectively analyzed.All of them were formed gradually after ankle trauma before the age of14,6cases were male and4cases female.The average age was17.4years old(from10to26years old).2cases were on the left side and8in the right side.6cases with scar contracture on the inside of ankle,and4cases with leg length discrepancy.In the preoperation,we analysed the ankle deformity,confirmed CORA,drew up a operating plan,and assembled external fixator.We used minimally invasive supramalleolar osteotomy and Ilizarov fixator to treat ankle varus deformity,of which calcaneus osteotomy were used in2cases.In the postoperation,we remedied ankle deformity by adjusting the Ilizarov fixator,2cases also involved limb lengthening.The functions of the ankle were assessed by the American Orthopaedic Foot&Ankel Society(AOFAS)scoring system.Results All patients were followed up.A mean follow-up of36(12-96)months showed that all the patients were satisfied with the appearance and function improvement after orthopaedic surgery.The patient's surgical incision healed smoothly,walked on the ground3to5days after operation.The average fixating time was16(12-24)weeks.2children with both correcting and limb lengthening had a degree of recurrent ankle varus.The average preoperative AOFAS score was40(30-65),with an average of85points(75-95points)after operation.Conclusion Ilizarov method has the advantages of minimally invasive,less soft tissue complications,flexible and adjustable,simultaneous correction of combined deformities,early weight-bearing,favorable bone healing,soft tissue reconstruction and satisfactory mechanical line restoration in children with ankle fracture.