摘要
背景:胫骨截骨延长具有创伤程度轻,痛苦小、所延长骨质愈合速度快、延长幅度大等优点,但常伴有一些术后并发症。其中以足下垂较为常见,同时其是在临床上较难处理的并发症之一。目的:比较应用Ilizarov与Orthofix外固定架行胫骨截骨延长后足下垂的发生率。方法:回顾性分析2012年7月至2014年5月由新疆大学第一附属医院显微修复外科行胫骨近端截骨延长修复胫骨缺损148例患者的临床资料,根据应用的外固定架种类分为2组,其中Ilizarov外固定架组72例,Orthofix外固定架组76例。比较2组患者胫骨近端截骨延长后足下垂的发生率。结果与结论:1随访1-1.3年,所有患者胫骨缺损处均获得修复;237例患者出现足下垂并发症,其中Ilizarov外固定架组26例,Orthofix外固定架组11例,Ilizarov外固架组患者足下垂发生率显著高于Orthofix外固架组(36%,15%,P<0.05);337例患者中28例足下垂症状得以改善;余9例患者因失去随访出现严重足下垂症状,患者自我功能锻炼和踝关节关节松动术等措施无法纠正患肢足下垂症状,此9例患者最终行跟腱延长术后患肢足下垂症状才得以改善;4结果提示,采用Ilizarov外固架行胫骨近端截骨延长患者足下垂的发生率明显高于采用Orthofix外固架的患者。同时作者认为胫骨截骨延长后足下垂的发生与患者本身、外固定架等有着一定的相关性。因此严格掌握手术技能,术前认真设计、术中精细操作、术后严密随访及时处理是减少胫骨截骨延长后足下垂并发症的关键。
BACKGROUND：Tibial lengthening osteotomy has the advantages of light trauma,less pain,fast healing of bone that extended,and large amplitude of extension.However,it is often accompanied by a number of postoperative complications,among which postoperative foot drop is more common.It is one of the complications that is more difficult to deal with clinically.OBJECTIVE：To compare the incidence of foot drop after tibial lengthening osteotomy using Ilizarov external fixator and Orthofix external fixator.METHODS：Clinical data of 148 patients with tibial defects treated by tibial lengthening osteotomy in the Department of Micro-Reconstructive Surgery,First Affiliated Hospital of Xinjiang Medical University from July 2012 to May 2014 were retrospectively analyzed.All patients were divided into two groups according to the type of fixators：Ilizarov external fixator group（n=72） and Orthofix external fixator group（n=76）.The incidence of foot drop after tibial lengthening osteotomy was compared between the two groups.RESULTS AND CONCLUSION：（1） Follow-up time was 1-1.3 years.Tibial defects of all patients were repaired.（2） There were 37 patients with foot drop,including 26 cases in the Ilizarov external fixation group and 11 cases in the Orthofix external fixation group.The incidence of foot drop was significantly higher in the Ilizarov external fixator group than in the Orthofix external fixator group（36%,15%;P〈0.05）.（3） The foot drop was improved in 28 cases among the 37 patients.The remaining nine patients were lost to follow-up,so they affected severe foot drop.Self functional exercise and ankle joint mobilization could not correct the foot drop.Achilles tendon lengthening improved the foot drop.（4） These findings verify that the incidence of Ilizarov external fixator on tibial proximal osteotomy in patients with foot drop was significantly higher than that of the Orthofix External fixator.The authors believe that the occurrence of foot drop after tibial osteotomy is associated with the patient＇s own and external fixation.Therefore,strictly surgical skills,preoperative careful design,intraoperative fine operation,postoperative follow-up and timely treatment are the keys to reduce foot drop after tibial lengthening osteotomy.
出处
《中国组织工程研究》
CAS
北大核心
2016年第22期3279-3286,共8页
Chinese Journal of Tissue Engineering Research
