Ilizarov外固定架辅助治疗儿童单纯性并指(趾)畸形

Outcome of Syndactyly Release with Ilizarov External Fixator

目的探讨利用微型Ilizarov外固定牵伸装置辅助治疗儿童单纯性并指(趾)畸形的临床效果。方法我科自2016年1月至2020月1月共收治7例单纯性并指(趾)畸形患儿,其中男4例,女3例;年龄1.5~6岁,平均年龄(3.0±1.6)岁;左侧2例,右侧5例。均采用微型Ilizarov外固定牵伸装置行并指(趾)间皮肤牵伸,术后3d开始延长,每天延长1~2mm。手术肢体采用支具外固定,待软组织牵伸获得充足皮源后,行并指(趾)皮肤“Z”形分离指蹼成形术。术后1、3、6、12个月进行随访,医生评估患儿的手指外观,瘢痕质量、指蹼瘢痕爬移、手指主动活动范围等,瘢痕情况采用温哥华评分评价。家长根据视觉模拟评分评估疼痛、外观和手指功能。结果7例患儿均获得随访,随访时间10~16个月,平均(12.0±2.3)个月。使用微型Ilizarov外固定牵伸装置行皮肤牵伸16~27 d后,均可获得1.5 cm以上的充足皮源,Ⅱ期手术分离并指(趾)时不再需要游离植皮,治疗过程中未出现外固定针眼感染、外固定针脱落、皮肤坏死以及瘢痕爬移等症状。末次随访时所有患者掌指关节及指间关节屈伸活动良好,均无瘢痕挛缩等并发症发生。温哥华评分为0~2分,平均(0.6±0.8)分。色素沉着、柔韧性和指蹼高度分别为(0.4±0.5)分、(0.1±0.3)分和(0.3±0.5)分。家长提供的视觉模拟评分(visual analogue scale,VAS):疼痛1~4分,平均(2.0±1.2)分;外观0~2分,平均(0.7±0.8)分;功能0~1分,平均(0.4±0.5)分。结论基于Ilizarov的张力-应力法则,使用微型Ilizarov外固定牵伸装置缓慢牵张治疗并指(趾),构型简单、护理方便,可以获得充足皮源,Ⅱ期手术时不影响患指血运,不再需要自体取皮和游离植皮,是治疗单纯性并指(趾)的一种有效方法。

Objective To introduce a new method of releasing syndactyly with the Ilizarov external fixator.Methods From Janurary 2016 to Janurary 2020,7 cases of cutaneous syndactyly were treated with the Ilizarov external fixator in our hospital.There were 4 males and 3 females,with an average age of(3.0±1.6)years(range:1.5~6.0 years).There were 2 cases on the left side and 5 cases on the right side.Mini Ilizarov external fixators were used to stretch the skin between the fingers(toes).The extension started 3 days after the operation and lasted for 1~2 mm every day.The wrist was fixed with brace.When sufficient skin was obtained,the“Z”shape flap plasty was performed.Follow-up was conducted at 1,3,6 and 10 months after the operation.Doctors evaluated the appearance of the children's fingers,scar quality,finger web scar,active range of motion,etc.Vancouver score was used to evaluate the scar condition of the wound.Parents assessed pain,appearance,and finger function based on visual analogue scale.Results 7 cases had been followed up with an average time of(12.0±2.3)months,(range:10~16 months).After 16~27 days of skin stretching with mini Ilizarov external fixator,more than 1.5 cm skin could be obtained.Free skin grafting was no longer needed in releasing operation.There was no infection,falling off of external fixator,skin necrosis,scar contracture and other complications during the treatment.The appearance and function of the released fingers were satisfactory.Vancouver score was 0~2,with an average of(0.6±0.8).The average scores of pigmentation,Pliability and web height were(0.4±0.5),(0.1±0.3)and(0.3±0.5).The VAS score provided by parents was 1~4,with an average of(2.0±1.2),appearance was(0.7±0.8)(range:0~2),function was(0.4±0.5)points(range:0~1).Conclusion The Ilizarov external fixator designed according to Ilizarov's tension stress law has the advantages of simple operation,convenient nursing and had abtained sufficient skin source.It does not affect the blood supply of the released fingers and does not require autografts.It is an effective method to treat simple syndactyly.