摘要
目的：探讨Ｉｌｉｚａｒｏｖ技术治疗下肢畸形出现的并发症及对策。方法：应用Ｉｌｉｚａｒｏｖ技术治疗下肢短缩１２例（１４个肢体），先天性胫骨假关节２例，骨髓炎骨缺损１例，矫治先天性马蹄内翻足９例。结果：２４例均达到预期畸形矫正目的。在股骨和胫骨畸形矫正中发生轴向偏移３５．２９％，针道感染２９．４１％，肌肉关节挛缩３５．２９％，延迟愈合５．８８％。并观察到带架下地活动时下肢外展，足呈外翻位致截骨处出现外翻应力是轴向偏移重要因素。延长超过４ｃｍ将出现肌肉关节挛缩，强力功能训练不能克服８～１０ｃｍ延长所致的挛缩。足畸形矫正中跖骨切割３３．３３％，跗间关节强直、针道感染分别高达５５．５６％和７７．７８％。结论：克氏针足够张力和改变引起下肢出现外翻应力的姿态以及对严重短肢畸形分次延长可减少轴向偏移和肌肉关节挛缩。Ｉｌｉｚａｒｏｖ技术不是治疗先天性马蹄内翻足首选方法。
Objective: To study the complications and management of Ilizarov technique in treatment of lower extremital deformity. Methods: the Ilizarov technique was used in 12 patients(14 legs)with short leg, 2 with congenital tibia pseudoarthrosis, 1 with bone defect following osteomyelitis and 9 with congenital clubfoot. Results: Prospective goals of correction were made in all the cases. Of them, axial deviation was found in 35.29%, pin tract infection in 29.41%, knee joint and muscle contracture in 35.29% and delayed consolidation in 5.88%. An important factor causing axial deviation was valgus stress at the site of osteotomy resulted from the abducted legs and the outward deviated feet while patient was walking in device. More than 4 cm of lengthening might raise the risk of knee joint and muscle contracture. Contracture resulted from 8～10cm lengthening would hardly be prevented by intensive physical therapy. In the cases of clubfoot, wirecutting of the matatarsal bones was found in 33.33%, rigidity of the intertarsal joint and pin tract infection in 55.56% and 77.78% respectively. Conclusions: High tension of Kwire, correct posture of walking and proper lengthening for severe shortness of the leg can reduce the incidence of axial deviation and joint or muscle contracture. Ilizarov technique shouldn't be considered as the first choice of the treatment for congenital clubfoot.
出处
《中华小儿外科杂志》
CSCD
1998年第2期110-112,共3页
Chinese Journal of Pediatric Surgery
