应用Ilizarov支架一期矫正儿童创伤后下肢成角伴短缩畸形

目的 探讨应用Ilizarov支架以一期手术、渐进矫形的方法治疗儿童创伤后下肢成角伴短缩畸形的可行性以及根据畸形的病理变化正确组装支架的方法.方法 对2005年3月至2007年9月间收治的6例创伤后下肢成角伴短缩畸形患儿采用上述方法治疗.术前常规拍摄双下肢全长站立位X线片,测量患肢短缩和成角畸形的程度并确定成角旋转中心的位置.术中安装支架时,铰链安置在成角旋转中心水平.术后7 d开始通过调整支架螺杆渐进矫正成角和短缩畸形并且每2周拍摄X线片观察畸形矫正和新骨生长情况.全长X线片证实恢复了下肢机械轴线和长度后停止调整支架,每月拍摄X线片复查,待新生骨痂矿化满意后去除外固定支架.随访中记录肢体长度、畸形有无复发以及关节活动范围,并根据X线片观察下肢力线、关节水平线与机械轴线角度以及新牛骨塑形情况.结果 6例患儿中除1例于骨折畸形愈合部位截骨矫形,邻近骨段延长外,余5例均利用微创截骨部位完成矫形与延长.术后平均矫正成角畸形34.8°(20°～58°),平均延长5.3 cm(3.5～6.5 cm).所有患儿下肢机械力线恢 复,相关关节角度恢复至正常范围,双下肢等长.末次随访时X线片显示延长骨痂愈合良好.结论 应 用Ilizarov支架一期矫正儿童下肢成角伴短缩畸形安全、可靠,可精确恢复下肢长度与机械轴线.术前 须科学分析畸形的病理变化,正确设计支架铰链的水平与位置.

Treatment of angulation and shortening deformity of the lower extremity after trauma in children with llizarov apparatus

Objective To evaluate the treatment of angulation and shortening deformity after trauma of the lower extremity in children with Ilizamv apparatus and discuss how to place the hinges at the right position according to the state of deformity. Methods From March 2005 to September 2007, 6 children with the sequelae of angulation and shortening deformity after trauma of the lower extremity were treated with Ilizarov apparatus gradually during one stage. The extent of shortening and angulation deformity were measured according to the full length X-ray film which were taken at the standing position. The center of rotation of angulation (CORA) was identified on the film, and during operation, the hinges of the Ilizarov apparatus were placed at the level of CORA. The apparatus were adjusted to correct the angulation and shortening deformity simuhaneouly 7 days after operation. The X-ray film was taken once 2 weeks during the period of adjustment. After the realignment of mechanical axis and recovery of leg length were confirmed on the full length film, the X-ray film was taken once a month. The apparatus were removed after consolidation of the new bone was enough. During follow-up, the leg length and range of motion were recorded clinically, the mechanical axis and articular angle as well as the remolding of the new bone were observed radiographically. Results The angulation was corrected at the deformity site and bone lengthening was performed at the adjacent segment in one case, all other 5 cases completed the deformity correction at the osteotomy site. The extent of angulation correction averaged 34.8° and bone elongation averaged 5.3 cm. The mechanical axis was realigned in all cases, articular angle was within the normal range and the leg length was equal. X-ray film at the latest follow-up showed good healing of the newborn bone, no fracture was observed. Conclusion It is a good and safe method to treat the angulation and shortening deformity in children simultaneously with llizarov apparatus. But the correct position of the hinges according to the deformity is mandatory.