Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形

目的探讨Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形的手术方法、术后管理程序及疗效。方法2004年2月～2007年5月，根据Ilizarov张力一应力法则，应用自行研制的外固定矫形器治疗伴有皮肤瘢痕挛缩的足踝畸形12例，其中马蹄内翻足10例，马蹄外翻足2例。9例同期实施足跗骨的有限截骨术，3例实施足部肌腱转移肌力平衡术，1例同期实施胫骨延长术。术后5d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，足内翻者先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准，足外翻者牵拉矫形的方向与内翻足相反。在矫形的过程中定期进行x线检测，以防止发生踝关节前后移位。治疗期间鼓励患足负重行走。术后平均牵伸78d，停止牵伸后在外固定器维持下患足负重行走平均69d，拆外固定器后配矫形鞋行走2～3个月。结果12例患者术后随访5个月～2年4个月（平均1年5个月）。8例足畸形获满意矫正，能全足底负重，行走功能良好，患者满意。4例足下垂畸形出现部分复发，其中3例再次安装足踝牵伸器矫正。最终疗效11例满意，1例可。僵硬的瘢痕组织经牵拉后血液循环改善，皮肤瘢痕变软。无一例发生严重针道和皮肤切口感染，未并发踝关节脱位及血管、神经损伤等并发症。结论改良的Ilizarov微创技术能有效矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形，合并骨性畸形者应配合有限截骨手术，但牵拉过程必须缓慢。足踝畸形达到矫形要求后，患足全负重行走不少于8周再拆除外固定器，可避免或减少畸形反弹。皮肤瘢痕组织在张应力作用下，可出现血液循环改善与组织再生的现象。     

Ilizarov技术矫正手与前臂畸形的临床应用研究

[目的]探讨用Ilizarov技术矫正手与前臂畸形的器械研制、手术方法与疗效。[方法]2例桡骨感染性大段缺损,伴肘、腕关节畸形,年龄11和12岁。3例手外伤后形成瘢痕挛缩畸形,其中手虎口挛缩1例;第2、3手指蹼挛缩1例;食指重度屈曲挛缩1例,年龄13~27岁。前臂缺损牵伸治疗应用标准的Ilizarov器械与技术,手的畸形矫正应用自行研制的微型骨外固定牵拉器,并进行了穿针布局和牵拉应力的测试,术后按要求缓慢旋转螺纹杆,使疤痕挛缩的组织产生持续的张力,缓慢矫正畸形,其中2例前臂缺损和1例指蹼挛缩者,结合实施了有限度的骨性与软组织手术。[结果]5例病人治疗结束后平均随访7个月,全部达到满意的矫形治疗效果,功能较术前获得明显改善,未出现并发症。[结论]应用Ilizarov技术修复前臂的残缺,矫正手的畸形,具有微创、简单、疗效确切的优点,不会产生严重的手术并发症。     

可调组合式足踝畸形外固定矫形器的系列构型与临床应用原则

目的介绍可调组合式足踝畸形外固定器的系列构型及探讨该装置的临床应用原则。方法在原来Ilizarov器械的基础上改进了一些适合国人的外固定矫形器,新设计的足踝部外固定器,仅由几组环和不同的配件组成,足踝部的马蹄、高弓、内外翻等畸形,根据情况只需增加、减少零部件或少许改变器械构型,就能够同时矫正。结果该组合装置经过临床应用,证实了器械结构合理性,具有结构简单,操作方便的优点。适用于脊髓灰质炎后遗症、外伤、脊椎裂后遗症、先天性疾病等各种原因引起的足踝畸形。不但避免很多严重的并发症,而且取得了非常满意的临床效果。结论新型的踝足外固定器,拓宽了手术指征,治疗了一些既往传统骨科难以治疗的重度踝足畸形,取得了非常理想的效果。在遵循人体自然规律和基本法则的前提下,按照Ilizarov技术的理念,重建人体的结构与功能,形成一套更加完善的外固定治疗体系。     

Ilizarov技术矫正畸形的原则

1前言畸形是指正常骨或关节解剖结构的改变,矫正畸形是矫形外科的主要工作内容。Ilizarov技术的引入对畸形的理解和处理产生了深远的影响。以前骨科医生习惯于在正侧位X线片上分开测量畸形,矫正骨性畸形是通过闭合或开放的楔形截骨,使之产生一个相等或相反的畸形角度来实现的。     

Ilizarov技术矫正儿童僵硬型马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正僵硬性马蹄内翻足畸形的方法和效果。[方法]作者在2000年3月～2005年3月间，使用Ilizarov技术矫正9例11足重度僵硬性马蹄内翻足畸形，将连接于胫骨、跟骨、跖骨的外固定环互相连接、组合成复杂的三维外固定架，通过逐渐调整外固定架矫正畸形，从而使患足达到或接近正常足的外形和功能。[结果]按Garceau标准评定疗效，优6足，良4足，差1足。[结论]Ilizarov外固定架三维矫正马蹄内翻足畸形效果确实，尤其适用于大年龄儿童之僵硬、复发或难治性马蹄内翻足，有一定的临床应用价值。     

Ilizarov技术—膝关节、足踝畸形矫正与功能重建新进展学习班通知

由中华医学会继续教育部和北京市垂杨柳医院、北京骨外固定技术研究所共同主办、浙江医科大学附属第二医院骨科联合协办的第三届＂Ilizarov技术—膝关节、足踝畸形矫正与功能重建新进展＂学习班,定于2011年4月8～10日（周五周日）在杭州举行。     

国家级Ilizarov技术-膝关节、足踝畸形矫正与功能重建新进展学习班通知

由中华医学会继续教育部和北京市垂杨柳医院、北京骨外固定技术研究所共同主办、浙江医科大学附属第二医院骨科联合协办的第三届＂Ilizarov技术-膝关节、足踝畸形矫正与功能重建新进展＂学习班,定于2011年4月8～10日（周五～周日）在杭州举行。     

Ilizarov技术矫治马蹄足畸形的临床应用进展

严重的马蹄足畸形临床表现多较复杂,传统的外科手段很难获得满意的疗效,且创伤较大,使本已变小的足变得更小。本文复习了Ilizarov技术在治疗马蹄足畸形方面的应用,结合作者单位的经验,较为详细地论述了马蹄足畸形的特点,相关的评价标准,Ilizarov技术的优势及原理,器械的设计安装及矫治程序,与传统手术方式的结合及合理的截骨方式选择,以及有关的并发症防治。以最大限度发挥Ilizarov技术的优势,保证最佳的治疗效果。     

国家级Ilizarov技术——膝关节、足踝畸形矫正与功能重建新进展培训班通知

由中华医学会继续教育部和北京市垂杨柳医院矫形外科共同主办,Ilizarov生物学理论与技术为代表的现代骨外固定技术,“Ilizarov技术——膝关节、足踝畸形矫正与功能重建新进展”培训班,定于2010年4月9～11日（周五～周日）在北京举行,4月8日（周四）全天报道。     

国家级Ilizarov技术-膝关节、足踝畸形矫正与功能重建新进展学习班通知

由中华医学会继续教育部和北京市垂杨柳医院、北京骨外固定技术研究所共同主办、浙江医科大学附属第二医院骨科联合协办的第三届＂Ilizarov技术-膝关节、足踝畸形矫正与功能重建新进展＂学习班,定于2011年4月8～10日（周五～周日）在杭州举行。学习班注册者可获得国家级1类医学继续教育学分6分。主要课程：（1）Ilizarov技术的起源与世界传播、发展史（2）从生物骨骼的起源、演变探索肢体损伤与重建的发展史（3）骨段滑移延长技术治疗骨不连、骨缺损（4）下肢体延长与重建系列创新手术     

Correction of poliomyelitis foot deformities with Ilizarov method

Poliomyelitis is an infectious disease caused by a neurotrophic virus targeting anterior horn cells of lower motor neurons resulting in flaccid paralysis and represents a common condition in developing countries, and even nowadays, most of both treated and untreated cases result in foot deformities. Between 1994 and 2007, 27 patients were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. Additional procedures were performed if needed. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered. In conclusion, the Ilizarov method allows simultaneous progressive correction of all components of severe foot deformities associated with limb-lengthening discrepancy with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding important shortening of the foot.     

Preoperative Ilizarov frame construction for correction of ankle and foot deformities

The Ilizarov method is being used increasingly to correct many orthopedic deformities. The frames required for ankle and foot deformity correction are among the most difficult to construct owing to the complexity of the deformities which must be corrected. A technique using a rubberized material (Pedilen) to create an exact replica of a preoperative ankle and foot deformity is described. This exact model, both in size and shape, may then be used on a workbench to preconstruct an Ilizarov frame that resembles the patient's deformity exactly in three dimensions with respect to size and shape. This allows thoughtful frame construction before operation reducing operating time and minimizing frustrations that may arise with complex deformities.     

Ilizarov reconstruction of chronic bilateral calcaneovalgus deformities

Calcaneovalgus foot deformities are present in up to 35% of patients with lumbar spina bifida. Resultant heel weight bearing causes complications include those associated with pressure ulcers. Early surgical reconstruction is advocated to prevent deformity progression and rigidity. Several surgical techniques in paediatric populations have been described, but there remains a paucity of literature regarding reconstruction of chronic calcaneovalgus feet in adults. This case report describes our experience using the Ilizarov technique in the reconstruction of an adult presenting with chronic calcaneovalgus feet. This is a 34-year-old lady with myelomeningocoele spina bifida of lumbar level 5 who presented with a history of multiple admissions for cellulitis and infections of bilateral heel pressure sores. Rigid calcaneovalgus deformities of both feet (45 on the right, 40 on the left) were noted on clinical examination and radiological investigations. Reconstruction with an Ilizarov frame allowed for gradual correction of both soft tissue and bone, correcting heel weight bearing ambulation, with the aim of preventing further complications from infected heel ulcers. While the correction of bony deformities is crucial, management of chronically contracted soft tissue must not be overlooked. An Ilizarov frame requires both an experienced surgeon and a motivated patient, but it allows for accurate reconstruction of bony deformities, while allowing management of surrounding chronic soft tissue contractures with good functional outcome.     

Versatility of Ilizarov external fixator in management of foot and ankle deformity

Abstract Traditional methods of correcting foot deformities may be difficult to apply in some conditions, especially in presence of other lower limb problems. This study discusses the versatility of Ilizarov external fixator (IEF) in such cases. It was performed in 34 foot deformities in 33 patients, treated with IEF between 1997 and 1999. The average age of the patients was 15 years. The aetiology of foot deformity was recurrent congenital talipes equinovarus (n=10), neglected congenital talipes equinovarus (n=3), poliomyelitis (n=9), post-traumatic deformity (n=6), post-burn deformity (n=1), arthrogryposis multiplex congenita (n=2), and cerebral palsy, fibular hemimelia and tibial hemimelia (1 case each). Unconstrained IEF was applied for the foot in all cases. The leg construct was applied according to the target: foot deformity alone or associated with other leg problems. IEF construct was extended to the femur in cases with flexion knee deformity and hinges were added. Follow-up continued until overcorrection was maintained for the same period of correction followed by an appropriate cast for 8 weeks. The mean time for deformity correction and Ilizarov stabilisation was 16 weeks, and follow-up period was 23.1 months. The results were good in 31, fair in 2 and bad in 1. Additional procedures were performed, most often in the same operating time. Primary arthrodesis was done for 5 feet and for one revision of failed previous arthrodesis. Open corrective osteotomy for arthrodesis was performed in 2 cases. Two females were treated for flexion knee with bloodless technique. Wire-site infections, wire cut-through a calcaneum and metatarsals and fracture post-IEF removal were observed. Although it is technically difficult, IEF can be considered an effective and versatile way of treating foot and other associated lower limb problems through one-reconstruction attack.     

Ilizarov技术矫治复杂僵硬性马蹄内翻足

 目的 探讨Ilizarov技术矫治复杂僵硬性马蹄内翻足的临床疗效。方法 回顾性分析2005年7月至2011年7月28例（41足）僵硬性马蹄内翻足患者的病例,男18例（26足）,女10例（15足）;年龄3~45岁,平均15.3岁;左足8例,右足7例,双足13例。根据Diméglio畸形分级：Ⅲ级31足,Ⅳ级10足。23足采用有限软组织松解、18足配合有限截骨后均安装Ilizarov外固定牵伸器。比较术前及末次随访时踝关节跖屈及背伸角度、踝关节活动度、正侧位X线片上患足距跟角的变化。结果 28例患者均获得随访,随访时间5~38个月,平均25个月。术后外固定支架佩戴2~14个月,平均5.1个月;去除支架后所有患足均获跖行步态,外形接近正常,无足短缩。足背伸角度：术前-45.0°±12.0°,末次随访9.5°±5.5°;跖屈角度：术前67.0°±14.0°,末次随访45.5°±7.8°;正、侧位X线片距跟角：术前分别为6.5°±4.5°和5.5°±11.0°,末次随访分别为22.5°±5.5°和40.6°±8.5°。1足术后发生急性血管痉挛性缺血,予减缓牵伸速度后缓解;5足发生针道感染,予更换针道及换药后感染控制。去支架后3个月,1足出现畸形复发,予二次矫形;3足畸形残留,5足趾屈曲挛缩,均给予二次软组织矫形术,未再复发。结论 Ilizarov技术矫治复杂僵硬性马蹄内翻足疗效确切,能最大程度保留足外形和功能,避免足短缩,不影响足发育。     

Ilizarov外固定器矫正膝关节畸形

 目的 总结Ilizarov外固定器矫正膝关节畸形的临床特点与效果。方法 回顾性分析2003年5月至2010年4月,采用Ilizarov外固定器矫正膝关节畸形的21例（22膝）患者资料,男12例,女9例;年龄8~38岁,平均20.3岁。致畸原因：儿麻后遗症4例,烧伤后遗畸形2例,骨髓炎后遗畸形2例,创伤后遗畸形9例,Blount病2例,多发性骨软骨瘤病2例。其中软组织屈曲挛缩5例,采用跨关节铰链Ilizarov支架组合,后侧逐步牵伸矫正;单纯骨性成角畸形8例（9膝）、骨性成角畸形伴骨短缩7例,采用4柱铰链支架组合,先矫正成角畸形,再牵伸延长矫正骨短缩;骨与软组织复合畸形1例,采用以上两种支架的叠加组合。结果 21例患者佩戴Ilizarov支架的时间为12~36周,平均22.3周;拆除支架时膝关节畸形均获满意矫正,其中16例（17膝）截骨或骨延长者均获得坚实骨性愈合。所有患者均获6~86个月随访,平均32.1个月。关节活动度由术前的102.14°±49.36°改善为随访时126.90°±24.31°。根据日本骨科协会（Japanese Orthopaedic Association,JOA） 膝关节骨关节炎治疗效果判定标准评定患膝功能,术前为（50.24±23.64）分,随访时为（85.71±10.52）分。所有患者随访时均可不扶拐徒手行走,且均可独立生活。2例患膝关节活动度＜ 90°,不能下蹲。结论 Ilizarov外固定器矫正膝关节畸形疗效确切,具有手术创伤小,可随时灵活调整的优点,但也存在与长时间带架相关的缺点。     

Ilizarov技术治疗四肢畸形并发症分析

  目的 探讨Ilizarov技术治疗四肢畸形并发症的发生原因及防治经验。方法 回顾性分析2000年1月至2010年10月采用Ilizarov技术治疗并获随访的846例各种四肢畸形患者的病例,男508例,女338例;年龄1.2~72岁,平均25.7岁;上肢畸形16例,下肢畸形830例。对治疗过程中（术中、术后）出现的并发症的种类、严重程度、处理方法和结果进行统计学分析。结果 随访时间6~30个月,平均18个月。846例患者中,190例出现并发症,其中针道感染81例,关节活动障碍36例,皮肤热损伤6例,神经、血管损伤7例,骨延迟愈合8例,小腿骨筋膜间室综合征2例,关节脱位7例,断针5例,继发关节畸形8例,严重骨质疏松5例,皮疹6例,外固定器近端股骨干骨折4例,外固定器拆除后再骨折3例,畸形复发11例,其他1例。采用抗感染、功能训练、理疗、再次手术等方法进行对症处理,最终仍有13例遗留永久性功能障碍。结论 应用Ilizarov技术在术前准备、手术操作、术后处理的各个环节均可出现多种问题与并发症。减少并发症发生的主要措施是,临床医生在应用Ilizarov技术前需要进行严格、系统培训,掌握手术适应证,理解Ilizarov技术原理,术前组装好个体化外固定器,严格遵循标准化手术操作与术后处理程序。