Ilizarov技术治疗静脉畸形继发肢体挛缩

Ilizorov technique in the treatment of limb contracture secondary to venous malformation

目的总结应用Ilizarov技术治疗静脉畸形继发肢体挛缩的效果。方法2015年1月至2019年6月,北京大学第三医院成形外科及国家康复辅具研究中心附属康复医院矫形外科收治9例静脉畸形继发肢体挛缩患者,男4例,女5例,年龄9~35岁,平均19.5岁。其中屈髋屈膝畸形2例,单纯膝关节屈曲畸形4例,屈膝畸形合并马蹄内翻足畸形2例,腕关节屈曲畸形1例。诊疗过程在多学科综合治疗小组评估后实施,均采用Ilizarov技术治疗,根据解剖安全区外固定穿针和肢体畸形的临床特点,将预构的外固定器连接在相应的畸形肢体上,同时行挛缩肌腱的松解,术后调节外固定器实施牵拉控制,缓慢矫正肢体畸形,患处疼痛严重或进展迅速,影响生活质量者,可在超声引导下行聚桂醇泡沫硬化治疗,联合手法等物理方法促进关节功能康复。结果本组9例治疗过程中未发生神经血管损伤、异常出血、末梢血运障碍,未发生明显的针道以及切口的感染事件,未发生深静脉血栓。9例患者均获得6~40个月随访,平均30.5个月,所有挛缩的肢体畸形均获满意矫正,其中髋、膝关节屈曲畸形均获矫正,可伸直,腕、足踝关节畸形大部分矫正,疼痛消失。结论应用Ilizarov技术治疗静脉畸形继发肢体挛缩,微创、安全,效果满意。

Objective To summarize the effect of Ilizarov technique in the treatment of limb contracture secondary to venous malformation.Methods From January 2015 to June 2019,nine cases of limb contracture secondary to venous malformation,from Peking University Third Hospital and Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids,were treated with Ilizarov technique,including four males and five females,aged 9 to 35 years,with an average age of 19.5 years.There were two cases of flexion of the hip and knee,four cases of flexion of the knee,two cases of flexion of the knee with talipes equinovarus,and one case of flexion of the wrist.Ilizarov technique was used for treatment after the evaluation of the multi-disciplinary treatment team.According to the safe zone of wire fixation and the limbs deformities character,the preassembled external fixator was connected to the relevant deformed limbs,and the tendons were released at the same time.Limbs deformities were corrected gradually by adjusting the external fixator.For patients with severe pain or rapid development of the affected area,it is appropriate to perform ultrasound-guided injection of lauromacrogol and physical therapy to promote the function of joints.Results During the treatment,there were no neurovascular injury,peripheral blood circulation disorder,infection event of injection channel and incision,or deep vein thrombosis.The follow-up were 6 to 40 months,with an average of 30.5 months.All the contractures of the hip and knee joints,most of the deformities of the wrist and ankle joints were corrected and the pain disappeared.Conclusions Ilizarov technique is a minimally invasive,safe and effective method for the treatment of limb contracture secondary to venous malformation.