应用单边轨道式外固定架双平面截骨一期矫正股骨远端骨骺损伤后遗下肢短缩、成角畸形

One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator

目的探讨应用单边轨道式外固定架双平面截骨一期矫正儿童股骨远端骨骺损伤后遗下肢短缩、成角畸形的临床疗效。方法回顾性分析2017年5月至2019年12月郑州市骨科医院采用单边轨道式外固定架, 一期于股骨远端截骨即时矫形、股骨中上段截骨缓慢牵张延长治疗的5例股骨远端骨骺损伤后遗下肢短缩、成角畸形的患儿资料, 其中男2例、女3例, 平均年龄13.6岁(10~17岁), 平均短缩5.1 cm(3.9~6.5 cm), 股骨远端平均成角24.9°(17.0°~30.5°)。测量并分析患肢术前和末次随访时的股骨远端外侧机械轴夹角(mLDFA)、股骨远端后侧机械轴夹角(mPDFA)、机械轴偏移(MAD)、膝关节活动范围及双下肢长度。结果 5例患儿均获得随访, 术后平均随访22个月(15~32个月)。所有患儿下肢机械轴线恢复满意, mLDFA, mPDFA, MAD均恢复至正常范围, 肢体长度均达到术前计划, 平均延长5.6 cm(3.9~8.0 cm), 平均愈合指数为35.6 d/cm(29.0~45.0 d/cm), 末次随访时X线片显示牵张区骨痂及截骨端均愈合良好。牵张期结束时, 所有患儿屈膝活动度基本达到90°, 至末次随访时, 所有患儿膝关节活动正常。所有患儿无血管、神经损伤, 无髋、膝关节脱位, 无去架后再骨折、深部感染等并发症发生。结论应用单边轨道式外固定架双平面截骨一期矫正股骨远端骨骺损伤后遗下肢短缩、成角畸形安全、可行, 避免了多次手术, 提高了患儿治疗期间的舒适度。

Objective To investigate the clinical effectiveness of one-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator.Methods The data of 5 patients(2 males and 3 females)with angulation and shortening deformity in the lower extremity after epiphyseal injury of the distal femur were retrospectively analyzed.The patients underwent monorail external fixator assisted one-stage osteotomy correction of the distal femur and distraction osteogenesis of the middle and upper femur in Zhengzhou Orthopeadics Hospital from May 2017 to December 2019.The mean age was 13.6 years old(range:10 to 17 years old).The affected limbs were shortened by 5.1 cm on average(range:3.9 to 6.5 cm).The average angulation deformity of the distal femur was 24.9°(range:17.0°to 30.5°).The mechanical lateral distal femoral angle(mLDFA),the mechanical posterior distal femoral angle(mPDFA),the mechanical axis deviation(MAD),the range of motion(ROM)of the knee,and the length of the lower limbs before surgery and at the final follow-up were measured and analyzed.Results All patients were followed up for 22 months on average(range:15 to 32 months).For all the 5 patients,the mechanical axis was well realigned,mLDFA,mPDFA,and MAD returned to normal range,and the length of the affected limb achieved the goal as planned before the surgery.Besides,the affected limbs were lengthened by 5.6 cm on average(range:3.9 to 8.0 cm),and the median healing index was 35.6 d/cm(range:29.0 to 45.0 d/cm).The bone callus in the distraction area and the osteotomy end were well healed at the final follow-up,as indicated by the X-ray results.At the end of the distraction period,the flexion ROM of the knee in all patients reached basically 90°.By the final follow-up,all patients had a normal knee ROM.No vascular or nerve injury,dislocation of hips or knee joints,re-fracture after disassembly,deep infection and other complications were observed in all patients.Conclusions One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator is safe and feasible.The method requires no multiple operations and improves the tolerance of patients during the treatment period.