单边轨道式外固定支架辅助髓内钉治疗胫骨畸形

Management of tibia deformity with fixator assisted nailing technique

目的探讨外固定架辅助髓内钉(fixator assisted nailing,FAN)和胫骨截骨技术治疗胫骨畸形的效果。方法回顾性分析2011年1月至2017年12月间北京积水潭医院采用FAN技术治疗的5例(7侧)下肢畸形患者资料,其中男2例,女3例,年龄16~60岁,平均33岁。5例中包括2例佝偻病双侧畸形,创伤后骨折畸形愈合2例,1例先天性胫骨假关节,其中6侧膝内翻畸形;2例为左侧畸形,1例为右侧畸形,2例为双侧畸形。手术方法采用单边轨道式外固定支架固定胫骨,微创截骨,矫正畸形后胫骨髓内钉固定,所有患者均未植骨。测量并分析患肢术前和术后的胫骨近端内侧角(medial proximal tibia angle,MPTA)、机械轴偏移(mechanical axis deviation,MAD)、膝关节活动范围。结果5例患者均得到完整随访,随访时间12~60个月,平均32个月。患者截骨端在术后3~6个月愈合,平均为4.5个月。1例畸形矫正后继续延长14 mm。根据Paley骨的影像学评分标准,4例为优,1例为良;功能评分5例均为优。5例患者的6侧肢体手术后MAD达到术前计划的范围(内侧15 mm~外侧10 mm)。7侧肢体MPTA达到正常范围(84°~90°)。膝关节活动范围术前120°~135°,平均为125°,术后115°~130°,平均120°。所有患者对治疗方法和结果都表示满意。无一例发生感染和神经血管损伤。结论FAN技术结合了外固定支架安全、微创、便于调节,可准确矫正畸形的优点,以及髓内钉固定患者依从性高的特点,可有效地治疗胫骨畸形,术前需要谨慎评估选择合适的患者。

Objective To discuss the result of treating tibia deformity with fixator assisted nailing technique (FAN). Methods A total of 5 patients with 7 limbs of tibial deformity-were treated with FAN technique. Etiology: 2 patients with bilateral tibial deformity suffered from Ricket's disease, 2 patients were malunion after tibial fracture, 1 patient was congenital pseudoarthrosis of tibia. This is a retrospective study. The unilateral external fixator was mounted on the medial side of tibia, and thenthe minimal invasive osteotomy was performed. After the deformity was corrected, the intramedullary nail was inserted to fix the tibia. None of the patients need bone autograft. The pre-operation and post-operation medial proximal tibia angle (MPTA), mechanical axis deviation (MAD) and range of motion (ROM) were measured and analyzed. Results All the 5 patients were followed-up for 12-60 months (average 32 months). The osteotomy site united in 3-5 months (average 4.5 months) post-operatively. According to Paley’s imaging scores, 4 patients were excellent and 1 patient was good. According to Paley's functional result scores, 5 patients were excellent;according to Paley’s bone results evaluation, 4 patients were excellent and 1 patient was good. We achieved desired post-operative MAD (from medial 15 mm-lateral 10 mm) in 6 limbs. The MPTA in 7 limbs was corrected to normal (84°-90°). The ROM was not significantly changed before and after operation. The average ROM of knee before operation was 125°(120°-135°), and average postoperative ROM was 120°(115°-130°), No deep infection or neurovascular injury occurred. All patients were satisfied with the method and results of the operation. Conclusion FAN technique combines the advantage of external fixation and intramedullary nail, and it is a good method to treat tibial deformity, the patient should be carefully evaluated and selected for applying this technique.