[1]张睿,刘生和,阮洪江,等.基于Ilizarov技术的Achterman I型腓侧半肢畸形肢体功能重建的疗效分析[J].中华老年骨科与康复电子杂志,2023,(02):65-72.[doi:10.3877/cma.j.issn.2096-0263.2023.02.001]
　Zhang Rui,Liu Shenghe,Ruan Hongjiang,et al.Outcomes of limb reconstruction in treating achterman type I fibular hemimelia based on Ilizarov technique[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(02):65-72.[doi:10.3877/cma.j.issn.2096-0263.2023.02.001]
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基于Ilizarov技术的Achterman I型腓侧半肢畸形肢体功能重建的疗效分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2023年02期
页码:
65-72
栏目:
上肢
出版日期:
2023-04-05

文章信息/Info

Title:
Outcomes of limb reconstruction in treating achterman type I fibular hemimelia based on Ilizarov technique
作者:
张睿; 刘生和; 阮洪江; 余轶凡; 徐佳; 康庆林
200233 上海交通大学医学院附属第六人民医院骨科
Author(s):
Zhang Rui;  Liu Shenghe;  Ruan Hongjiang;  Yu Yifan;  Xu Jia;  Kang Qinglin
Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
关键词:
腓侧半肢畸形;  Ilizarov技术;  组合性手术;  肢体延长;  截骨矫形
Keywords:
Fibular hemimelia;  Ilizarov technique;  Composite surgery;  Limb lengthening;  Osteotomic orthopedics
DOI:
10.3877/cma.j.issn.2096-0263.2023.02.001
文献标志码:
A
摘要:
目的 探讨Ilizarov技术结合组合性手术治疗Achterman I型先天性腓侧半肢畸形的疗效，并总结先天性腓侧半肢畸形肢体功能重建治疗的诊治要点。方法 本研究回顾2014年至2021年收治的20例先天性腓侧半肢畸形患者，男12例，女8例，平均年龄（17.5±7.0）岁（4～26岁）；Achterman ⅠA型14例，ⅠB 型6例。针对肢体短缩采用单纯Ilizarov技术或内外结合进行肢体延长；对于膝外翻、踝外翻畸形，成人患者采用闭口截骨矫形内固定，儿童患者采用骨骺阻滞；松解和延长挛缩的髂胫束、腓骨肌腱和跟腱；肌腱转位纠正叠趾畸形。结果 20例患者平均随访（36.1±8.7）月，平均延长（7.2±1.0）cm，EFI（15.9±6.3）d/cm，HI（21.7±2.8）d/cm。所有患者末次随访时患肢短缩、膝外翻[GVA：术前（14.9±3.4）°，末次随访（2.1±1.7）°，t=13.510，P＜0.05]、胫骨弯曲畸形[TBA：术前（3.3±3.3）°，末次随访（0.8±0.7）°，t=3.490，P＜0.05]及足踝畸形[VAA：术前（9.2±3.4）°，末次随访（1.2±1.3）°，t=9.785，P＜0.05]均已得到矫正。LLRS AIM较术前明显改善[术前（10.1±1.2）分，末次随访（2.0±1.4）分，t=21.140，P＜0.05]。 结论 先天性腓侧半肢畸形存在复杂的肢体短缩、力线异常和足踝畸形，Ilizarov技术与髓内延长、组织松解、截骨矫形和骨骺阻滞等手术的结合在治疗先天性腓侧半肢畸形方面疗效满意，能够明显改善患者生活质量。
Abstract:
Objective To explore the clinical outcomes of combination of Ilizarov technique and composite surgeries for treatment of congenital fibula hemimelia, and to summarize the key points of limb reconstruction management for such deformity. Method Twenty patients with congenital fibula hemimelia were treated surgically and retrospectively studied in Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People’s Hospital since 2014. Patients included 12 males and 8 females, with an age of (17.5 ± 7.0) y (4 to 26 y). According to Achterman classification, there were 14 cases of type IA and 6 cases of type IB. Single Ilizarov technique or combined intramedullary assistance was applied for limb length deficiency; For genu valgus or valgus ankle deformities, close-wedge osteotomy and internal fixation were applied for adult patients, and hemiepiphysiodesis for pediatric patients; Contracted iliotibial band, fibular tendons and Achilles’ tendon were released and elongated; Overlapping toes were corrected by tendon transfer. Results Twenty patients were followed up for (36.1±8.7) months. The limb was lengthened for (7.2±1.0) cm, with average EFI (15.9±6.3) d/cm and average HI (21.7±2.8) d/cm. All obvious limb length discrepancy, genu valgus [GVA: (14.9±3.4)° and (2.1±1.7)° preoperatively and at last follow-up, t=13.510, P<0.05], tibial angulation [TBA: (3.3±3.3)° and (0.8±0.7)° preoperatively and at last follow-up, t=3.490, P<0.05] and ankle and foot deformities [VAA: (9.2±3.4)° and (1.2±1.3)° preoperatively and at last follow-up, t=9.785, P<0.05] were corrected at the final follow-up. Clinical outcomes indicated significantly improved limb function compared with preoperative grading. [LLRS AIM: (10.1±1.2) points and (2.0±1.4) points preoperatively and at last follow-up, t=21.140, P<0.05]. Conclusion Congeinital fibular hemimelia is a rare and complicated syndrome with co-exist limb length deficiency, abnormal alignment of lower-limb and foot and ankle deformities. Combination of Ilizarov technique and composite surgeries can bring satisfying outcomes for treatment of congenital fibula hemimelia and improve the quality of life of the patients.

备注/Memo

备注/Memo:
国家自然科学基金（82072421），上海市自然科学基金（20ZR1442200）
更新日期/Last Update: 2023-05-09