35075例手术治疗的肢体畸形残疾患者统计分析（秦泗河矫形外科1978.5.25—2018.12.31）

Surgical treatment of limb deformity and disability: a statistical analysis of 35 075 cases from QIN Sihe orthopaedic team between May 25, 1978 and December 31, 2018

目的总结秦泗河矫形外科团队手术治疗的35 075例肢体畸形残疾患者特点及矫治策略,为了解中国肢体畸形残疾病因、病种及矫形手术治疗提供大样本依据。方法查阅秦泗河矫形外科团队1978年5月—2018年12月肢体畸形手术病例数据库中的35 075例患者资料,对患者年龄、性别、畸形特点、病因及病种构成、地区分布、矫治手术方法等进行统计分析。结果35 075例患者中,男20 458例(58.33%)、女14 617例(41.67%);男女比例1.4∶1。年龄1~82岁,平均20.5岁;患者主要集中于11~25岁,达19 363例(55.20%)。手术以下肢33 259例(94.82%)为主。患者来自全国33个地区及国外12个国家。病因病种包括神经、遗传、代谢、创伤后遗症、先天性、血管、淋巴、皮肤、内分泌、医源性等202个,几乎涵盖了骨科所有亚学科。患者最多的前6种病种分别为脊髓灰质炎后遗症、脑性瘫痪后遗症、创伤后遗症、脊柱裂后遗症、膝内翻及膝外翻、先天性马蹄内翻足。40年间秦泗河矫形外科共使用手术方法280种,包括肌腱/筋膜松解术、肌腱转位动力平衡术、截骨术、骨延长术、关节固定术、骨牵引术、支具辅助牵伸术等。采用矫形手术联合骨外固定技术8 702例,其中Ilizarov环形外固定3 696例、组合式等外固定器5 006例。结论秦泗河矫形外科团队40年来收集的手术治疗肢体畸形残疾患者资料来源广泛,是目前中国最大的肢体残疾资料数据库,反映了能够通过矫形手术治疗的肢体残缺畸形的病因、病种、人群特点、手术方法概况等。

Objective To investigate the characteristics and corrective strategies of various limb deformities treated by QIN Sihe orthopaedic team in the past 40 years,so as to provide a large sample for understanding the causes,types,and treatment methods of limb deformity and disability in China.Methods A clinical data of 35 075 cases who were treated by QIN Sihe orthopaedic team between May 1978 and December 2018 was summarized.The age,gender,deformity characteristics,etiological and pathological composition,regional distribution,and surgical methods of the patients were analyzed.Results There were 20 458 males(58.33%)and 14 617 females(41.67%).The age ranged from 1 to 82 years(mean,20.5 years).The majority people(19 363 cases,55.20%)were 11-25 years old.Of which,33 259 cases(94.82%)were operated on lower extremity.The geographical distribution of patients covered 33 regions in China and 12 foreign countries.There were 202 etiologies involved neurological,heredity,metabolism,traumatic sequelae,congenital,vascular,lymphoid,skin,endocrine,iatrogenic,and so on.The disease covered all subsubjects of orthopaedics.The top six deformities secondary to poliomyelitis sequelae,cerebral palsy,traumatic sequelae,spondylolysis sequelae,genu varum and genu valgum,and congenital talipes equinovarus.There were 280 kinds of surgical methods,the majority of which were Achilles tendon lengthening,supracondylar osteotomy,subtalar joint arthrodesis,tibiofibular osteotomy,metatarsal aponeurosis,and Achilles tendon replacement of peroneal longus muscle,etc.Orthopaedic surgery combined with external fixation were applied in 8 702 cases,including Ilizarov fixator in 3 696 cases and Hybrid fixator in 5 006 cases.Conclusion QIN Sihe orthopaedic database with 40 years is the largest one of limb deformity and disability in China.It reflects the etiology,type,population characteristics,surgical methods and strategy of limb disability and deformity which can be treated by orthopaedic surgery.The data needs to be further excavated and deeply studied in future because of its important academic value and historical significance.