降低胫骨延长术后跟腱延长手术率的探讨——附82例报告

自1927年Abbott首次报告了胫骨延长术后,由于术式和延长器不断得以改进,尤其是近年来儿麻后遗症矫治工作越来越被人们重视后,该术也广泛为临床采用。但胫骨延长过程中最常见的并发症是跟腱挛缩致足下垂的防治,目前国人报告和论述的多为补行跟腱延长术加以纠正,而有效的防止方法却报告或论述得较为简单,故跟腱延长术常被视为胫骨延长术后的“姐妹手术”。     

距下松解术治疗复发性小儿马蹄内翻足畸形

目的：探讨治疗复发性马蹄内翻足畸形的手术方法。方法：距下松解术治疗复发性马蹄内翻足畸形１２例２０足，其中男１０例（１８只足），女２例（２只足），年龄１３￣４１月，平均２０月；复发时间４￣１６月，平均９月。结果：畸形纠正优良（足形态正常或前足轻度内收，踝关节活动好）为１９只足，占９５％，可（足跟部有较明显内翻）；１只足占５％，结论：距下松解术治疗复发性马蹄内翻足畸形疗效可靠，畸形可得到较好纠正。     

胫骨干骺端延长术88例临床分析

胫骨干骺端延长术８８例临床分析空军衡阳医院张义生，刘斌广州空军儿麻中心曾文彪，曾凯生下肢短缩畸形患者的矫治与康复，是处理小儿麻痹后遗症的重要问题￣［１］。我们从１９８５年起用胫骨干骺端截骨延长术治疗８８例肢体短缩病人，分析如下。１临床资料８８例中男４...     

跟腱延长术或胫前肌腱外移术配合中药熏洗治疗先天性马蹄内翻足畸形的疗效观察

目的观察跟腱延长术或胫前肌腱外移术配合中药熏洗治疗先天性马蹄内翻足畸形的临床疗效。方法选择2014年1月~2016年12月内在我院接受治疗的50例先天性马蹄内翻足畸形患者,按照入院先后顺序分为对照组、观察组各25例,分别行常规手术治疗和手术配合中药熏洗治疗,对比两组疗效。结果观察组患者的Ponseti优良率为96.00%(24/25),明显高于对照组的76.00%(19/25),差异明显(P0.05);治疗前两组患者正位跟距角、侧位跟距角、双踝角均较低,距跖角较高,组间对比无显著性差异(P0.05);经过治疗两组患者的马蹄内翻足影像学指标均有所改善,对比两组患者治疗后正位跟距角、侧位跟距角、双踝角水平和距跖角水平,差异具有统计学意义P0.05。结论先天性马蹄内翻足畸形患者予以跟腱延长术或胫前肌腱外移术配合中药熏洗治疗,可优化治疗效果,矫正畸形效果显著。     

Clayton术式治疗30例类风湿前足畸形

目的：介绍Ｃｌａｙｔｏｎ术式治疗类风湿性关节炎前足畸形。方法：切除前足第１～５跖骨头和近节趾骨近侧１／２。结果：全部随访半年～１２年，评价结果４０足中，优为３５足占８７．５％；良：３足占７．５％；中：１足占２．５％；差：１足占２．５％。结论：认为本手术方法简便易行，对消除前足部的外观畸形，减轻疼痛，恢复步行功能有较满意的疗效。     

逆转手法按摩和系列石膏固定治疗小婴儿先天性马蹄内翻足

目的:观察应用逆转手法按摩和系列石膏固定治疗先天性马蹄内翻足的疗效。方法:选择2004-01/2006-02郑州市儿童医院门诊就诊的先天性马蹄内翻足患儿29例41足,柔软型20例27足,僵硬型9例14足;平均年龄46d。于石膏室应用逆转手法按摩后行系列石膏固定治疗,矫正后应用矫形支具维持治疗。矫正标准:足部外展40°、外翻20°、背伸20°,提起患儿,其足部能在桌面上踏平。结果:24例34足通过手法按摩、系列石膏固定矫正,占83%(24/29),平均治疗时间6.3周;5例7足(均为僵硬型)畸形减轻,3例3足行经皮跟腱延长术,2例4足行肌平衡术。全部病例均获随访,随访6￣30个月,平均17个月。其中3例6足畸形复发,5足行经皮跟腱延长术,1足行肌平衡术。结论:应用逆转手法按摩、系列石膏固定治疗先天性马蹄内翻足效果显著。     

外固定胫骨干骺端延长术患者的围手术期护理

肢体延长术已广泛应用于矫正肢体长度不等,先天性或后天性畸形,修复各种骨缺损与骨不连[1]。通过矫正肢体短缩畸形,从而达到改善肢体功能的目的。我科2000年2月~2007年2月共为14例小腿短缩畸形患者,应用外固定延长器进行肢体延长,术后效果较为满意。现将护理体会报告如下。临床资料2000年2月~2007年2月对14例下肢短缩患者行胫骨延长术。其中男性10例,女性4例,年龄7~32岁,平均23.5岁。采用Ilizarov延长术9例、Wasserstein5例。全部病例于术后7~10天开始延长,以1~1.5mm/天的速度开始牵伸延长。2个月后停止延长。手术方法以胫骨结节稍下定为截…     

先天性胫骨弯曲并假关节形成1例报告

先天性胫骨弯曲并假关节形成系患肢胫骨一段先天性发育不良，早期胫骨向前弯曲，继而发生病理性骨折，形成严重的肢体畸形和功能障碍。国内文献少有报道，本文报告1例。1病例报告男，12岁。出生后即发现右小腿下端轻度弯曲前凸畸形及右足马蹄内翻畸形。1岁时曾行马蹄内翻足行矫形术。随年龄增长，右小腿弯曲畸形逐渐加重，但行走尚可。3月前不慎跌倒，致右小腿下端肿瘤，前凸畸形加重，不能行走，曾经手法复位、石膏托固定未见好转，于92年11月来我院就诊。患儿足月顺产，家族中无类似患者。体查：双下肢不等长．右较左短3cm，右小腿下端明…     

脑动静脉畸形的血管内栓塞治疗

目的：研究血管内栓塞治疗脑动静脉畸形（ｃＡＶＭ）的临床效果。方法：在数字减影全脑血管造影（ＤＳＡ）监视下,经股动脉插管,采用Ｍａｇｉｃ１．５￣１．８Ｆ微导管,α－氰基丙烯酸正丁酯（ＮＢＣＡ）栓寒剂对２１例脑ＡＶＭ患者行血管内栓塞。结果：完全栓塞达解剖治愈４例,脑ＡＶＭ团栓塞达９０％以上６例,７０％￣９０％９例,７０％以下２例,术后出现头晕、７头痛３例,２例栓寒后又行手术切除,３例栓塞后行γ－刀治疗     

胫骨骨骺及干骺端截骨延长术的康复护理

胫骨骨骺及干骺端截骨延长术.是均衡儿麻后遗症下肢短缩畸形的有效措施之一.我院于1984年11月开展了胫骨骨骺及干骺端截骨延长术.治疗儿麻后遗症下肢短缩畸形取得了满意效果。经过精心治疗和护理.53例病人无一例并发血管、神经损伤。现将护理体会报告如下。一、一般资料骨骺牵伸延长及干骺端截骨延长术:前者在儿童骨骺未封闭前,后者在成人骨骺封闭后采用的一种较     

6个月内婴幼儿先天性马蹄内翻足Ponseti疗法临床研究

目的评价6个月内婴幼儿先天性马蹄内翻足Ponseti疗法的效果。方法回顾性分析我院2007年9月-2011年9月采用Ponseti疗法治疗6个月内婴幼儿先天性马蹄内翻足54例86足的临床资料。结果全部病例均获随访,随访时间6～54个月,按Pirani标准评价疗效,优良率100％。所有患儿足外观畸形纠正,皮下触及跟腱连续有力,踝关节可背屈达10～20°,跟骨无内翻,高弓消失,无“摇椅足”发生,已行走的患儿足发育及关节功能良好,步态正常,X线表现正常。结论Ponseti疗法治疗6个月内婴幼儿先天性马蹄内翻足具有方法简单、效果确切等优点,是一种很好的保守治疗方法,可作为6个月内婴幼儿先天性马蹄内翻足的首选治疗方法。     

The impact of selected biological factors on bone regeneration in distraction osteogenesis

Background. Comparatively few reports have analyzed the biological factors influencing the course of distraction osteogenesis, such as the etiology and magnitude of shortening or the patient's age at surgery. The aim of our study was to assess the impact of selected biological factors on the course of bone regeneration in distraction osteogenesis of the lower leg. Material and method. We examined 126 patients, on whom 138 lower leg lengthening operations were performed. Congenital shortening was the most numerous cause (54.9%), followed by postinfectious (16.6%), posttraumatic (14.3%), neurogenic (7.9%), and achondroplastic (6.3%). The course of distraction osteogenesis was analyzed on the basis of duration of treatment, expressed by the lengthening index. Results. The highest lengthening index values were found in neurogenic patients, somewhat lower in congenital. The lowest lengthening index values were observed in postinfectious and posttraumatic shortenings, and in the group of bi-level lengthenings in achondroplastic patients. The lengthening index decreased along with increasing elongation. Lower lengthening index values were found in patients younger than 20 years, regardless of the method and number of osteotomy levels. Conclusions. There is clinical evidence for the impact of etiology, age, and magnitude of shortening on the course of distraction osteogenesis. The shortest treatment duration was found in shortening of acquired etiology and achondroplasia, and in patients older than 20 years. The values of the lengthening index were the lowest in lengthenings over 6 cm, whereas the greatest values were observed in lengthenings less than 4 cm.     

Leg lengthening in patients with congenital fibular hemimelia

Background. Anisomelia in patients with congenital fibular deficiencies is a difficult orthopedic problem due to concomitant deformities of the angle and knee. The goal of the present study was to analyze outcomes of tibia lengthening in these patients. Material and methods. In the period 1989-2001 we performed lengthening of 26 limbs in 21 patients with congenital fibular deficiency (11 female, 10 male, average age 10.1 years). Under the Achterman-Kalamchi classification, 8 tibiae were Type 1, 3 were Type 1b, and 10 were Type 2 (including one case with bilateral defect). The average baseline shortening was 4.6 cm, i.e. 15.3%. The Ilizarov method was used in 24 cases, chondrial lengthening in the others. We measured time of lengthening, time of stabilization, total healing time, amount of lengthening, and the lengthening index, as well as the range of ankle and knee movement, the positioning of the foot, and the axis of the tibia at each stage. Problems and complications were classified according to Paley. The average follow-up was 4.9 years Results. The mean time of lengthening was 101 days, stabilization time 177 days, total healing time 269 days, mean lengthening 5.6 cm (22.9%). As of the last examination only 7 patients did not require follow-up surgery, 6 with Type 1a and 1 with Type 1b. Conclusions. Tibia lengthening with axis correction constitutes an alternative to amputation in congenital fibular deficiency. It is a difficult procedure, however, encumbered by a significant risk of complications.     

Limb lengthening in automatic mode

Background. More than 5000 lengthening procedures in the upper and lower limb bones were performed at the Russian Ilizarov Scientific Centre, including 406 segments that were lengthened in automatic mode. Distraction was continuous, 24 hours a day, at a rate of 1 mm over 60 operating cycles of the autodistractor. Material and methods. Lengthening in automatic mode was used in 171 patients between the ages of 5 and 43. Monosegmental and polysegmental osteosynthesis techniques were applied. The amount of lengthening ranged from 3 to 16 cm. The mean value of lengthening by the monosegmental type of osteosynthesis was 6.1 +/- 2.0 cm, and by polysegmental techniques, 7.2 +/- 1.5 cm. The distraction forces developed in the autodistractor were also measured. In order to develop an objective opinion about the advantages of automatic distraction, we calculated the fixation index in the apparatus for one centimeter of lengthening. Results and conclusions. The fixation index was only 5-6 days/cm when using automatic distraction, but came to 22-24 days/cm by manual adjustment of lengthening. The biochemical study of bone metabolism during lengthening showed expressed activity of blood enzymes, such as alkaline and acid phosphatases, as well as large amounts of minerals in the distraction osteogenesis area.     

应用Ilizarov技术进行肢体延长

目的应用Ilizarov技术进行肢体延长,探讨其对骨愈合过程中的影响。方法1991/1999年应用Ilizarov技术治疗肢体不等长39例,男22例,女17例,年龄8～15岁,平均12.5岁。肢体短缩3～12cm,平均6cm,均采用改良干骺端皮质骨截骨术,术后7d开始延长,1mm/d,分2～4次完成。延长1周后拍X线片,了解截骨是否完全、截骨对位对线情况,如有轴向偏移等,随时调整。以后每3周拍X线片1次,了解延长情况,新骨形成情况,达到预期延长长度后停止延长,带外固定架至延长区获骨性愈合后去除外固定架。结果所有病例均达预期延长长度,延长2.0～14.5cm,平均7cm,胫骨延长3～12cm,股骨4～10cm,胫骨、股骨同时延长11.0～14.5cm,尺骨2.0～3.5cm,愈合指数25～43d/cm,平均31d/cm。结论Ilizarov延长技术合理,手术切口小,创伤小,骨膜剥离少,对局部血供破坏小,明显缩短了截骨愈合时间。     

Outcome of antenatally diagnosed talipes equinovarus in an unselected obstetric population.

OBJECTIVE: To investigate the natural history and outcome of fetal talipes diagnosed by routine ultrasound scanning at 18-23 weeks' gestation. PATIENTS AND METHODS: This was a retrospective study of 103 228 pregnancies undergoing routine ultrasound scanning at 18-23 weeks' gestation. A computer search was made to identify all cases of fetal talipes and the records of these patients were examined to determine the incidence of other defects and pregnancy outcome. RESULTS: The incidence of fetal talipes following routine ultrasound examination was 0.10% (107/103 228) and was bilateral in 64 (59.8%) and unilateral in 43 (40.2%) cases. In 52 (48.6%) cases, talipes was of complex etiology, as it was associated with other defects, while, in 55 (51.4%) cases, it was classified as idiopathic. In 19% of cases, an initial diagnosis of idiopathic talipes was changed to complex, because of the subsequent development of associated features. Perinatal death and long-term neurodevelopmental or musculoskeletal problems were significantly more common when the talipes was complex rather than idiopathic (odds ratio, 150; 95% confidence interval, 34-665). Adverse outcomes were also seen more frequently with bilateral compared to unilateral talipes (odds ratio, 3.44; 95% confidence interval, 1.50-7.90). CONCLUSION: The outcome of antenatally detected talipes is mainly dependent on the presence or absence of other defects. A significant proportion of cases, thought to be idiopathic at presentation, will develop associated complex features when reassessed on subsequent scans or postnatally.     

Distraction epiphysiolysis in the treatment of uneven limb length

Background. In view of difference of opinion regarding the clinical value of limb lengthening by epiphyseal distraction we decided to analyze our own experiences in this area. Material and methods. Our research involved 31 children, 18 girls and 13 boys ranging in age from 7 to 14 years, treated by means of epiphyseal distraction in 17 femoral and 14 tibial segments. The mean initial shortening of the leg was 6 cm. During lengthening and after its conclusion we evaluated the extent of lengthening, the quality of the regenerated bone, and the status of the growth plate. The average follow-up was 6 years. Results. The mean limb lengthening was 5 cm (range 3-8), the average duration was 110 days, with a mean time to stabilization of 48 days (range 30-106). The mean lengthening index was 42 days/cm. Conclusions. In our opinion epiphyseal distraction is a simple procedure for limb lengthening, relatively non-invasive, but requiring considerable experience on the part of the clinical staff. The maximum lengthening should not exceed 6 cm. Monitoring of the lengthening process is very important in order to guarantee good quality regenerated bone. Epiphyseal distraction should be performed just before the child completes growth.     

采用阴囊V形切口的Borsellino术治疗隐匿性阴茎疗效分析

目的 探讨通过改良Borsellino术治疗隐匿性阴茎的疗效。方法 选择2017年1月至2021年10月在海军军医大学第一附属医院泌尿外科诊治的74例隐匿性阴茎患儿，合并蹼状阴茎患儿21例。对所有患儿均采用阴囊V形切口的改良Borsellino术，并在术后1、3、6个月进行随访。分析患者手术时间、术后阴茎延长长度、术后并发症及手术满意度等。结果 患儿年龄(11.1±3.0)岁，平均体质量指数(BMI)为(23.0±4.5)kg/m²。手术时间为(82.9±16.7)min。术后阴茎延长长度为(2.97±0.21)cm，其中合并蹼状阴茎组延长长度为(3.05±0.18)cm，大于不合并组[(2.93±0.21)cm,P<0.05]。术后发生包皮水肿(3例，4.0%)、包皮切口瘢痕(4例，5.4%)、切口感染(2例，2.7%)与血肿(1例，1.4%)。患儿家属非常满意40例(54.1%)、满意27例(36.5%)、一般5例(6.8%)，不满意2例(2.7%)。结论 该改良Borsellino术对隐匿性阴茎有较满意的手术效果，尤其适用于合并蹼状阴茎的隐匿性阴茎患儿...     

The surgical treatment of short stature: management strategy and local experience

Background. This article presents the indications and counterindications for the application of limb lengthening using distraction osteogenesis in the treatment of patients with short stature. Various treatment strategies are described. The factors influencing the choice of strategy are discussed, the means used to determine the extent and level of lengthening, and the optimum age to begin treatment. Material and methods. On the basis of their own material the authors present the problems, obstacles, and complications occurring during treatment. During the period 1997-2000 a total of 5 patients were treated for short stature, averaging 18 years of age. In these cases the "crossed" technique of surgical treatment was applied, using an Ilizarov apparatus on the tibia and an Italian modification on the leg. Results. A total of 8 tibial segments (ave. 7 cm) and 8 femoral segments (ave. 7.5 cm) were lengthened. The average increase in stature was 14.8 cm (a 12% increase over the growth prior to treatment). Conclusions. The methods applied produced good results in patients with non-proportional dwarfism, while the majority of complications involved patients with constitutionally short stature. This confirms the necessity to make a strict selection of healthy persons undertaking to increase their stature for cosmetic reasons.     

Outcome of fetal talipes following in utero sonographic diagnosis.

OBJECTIVES: To examine the association between fetal talipes and other defects, and outcome in relation to postnatal surgery. METHODS: All cases of talipes presenting to the fetal medicine unit between 1993 and 1998 and cases of isolated talipes presenting to the ultrasound department between 1991 and 1998 were examined. The infants were followed-up to determine the number of cases that had structural or positional talipes and the number of cases requiring surgery. RESULTS: There were 76 cases, 59 of which attended the fetal medicine unit and 17 the ultrasound department. Postnatal follow-up details were available in 31 of the 40 live births. There were three neonates with unilateral talipes at birth who were thought to have bilateral talipes on prenatal ultrasound and one neonate had bilateral talipes at birth who had been thought to have unilateral talipes prenatally. In two (6.4%) neonates in whom talipes was not confirmed at birth the abnormality was diagnosed prenatally. Of the 29 neonates with confirmed talipes at birth, the defect was structural in 26 (90%) cases and positional in three. Surgery was necessary in 21 (72%) of the 29 cases and 18 (86%) of those undergoing surgery required only one operation. When live births with associated anomalies were excluded, there were 24 cases with confirmed isolated talipes and 18 (75%) required surgery. CONCLUSIONS: This study provides long-term outcome data which can be used to complement current prenatal counseling and shows that in cases of fetal talipes diagnosed prenatally, 90% have a structural rather than a positional deformity. For isolated talipes three quarters of children will require surgery and in the majority of cases only one operation on the foot is necessary. Parents should be made aware of the small possibility of a false-positive diagnosis and discrepancy between the ultrasound and postnatal diagnoses of laterality.