微创牵拉技术治疗小腿缺血性肌挛缩后遗重度踝足畸形

目的探讨用llizarov微创牵拉技术,治疗小腿缺血性肌挛缩后遗重度踝足畸形的疗效。方法根据llizarov张力-应力法则,自行研制了可调式具有三维矫形功能的踝足关节牵拉外固定器。2002年4月至2004年3月,应用微创牵拉技术治疗因下肢创伤、骨折等原因并发的小腿缺血性肌挛缩后遗固定性踝足畸形患者8例。其中男4例,女4例;年龄13—31岁,平均23岁。左下肢5例,右下肢3例。术前畸形类型：马蹄内翻足6例,马蹄足2例,伴有小腿广泛性瘢痕挛缩,其中5例既往行软组织松解手术矫正足畸形失败。术后牵拉时间29—60d,平均46d。结果8例患者均获得随访,随访时间10-29个月,平均13个月。畸形足皆获得满意矫正,能全足持重行走,功能良好,未发生针道感染、皮瓣坏死、血管、神经损伤等并发症。结论微创牵拉技术矫正缺血性肌挛缩后遗踝足畸形,具有安全、微创、效果满意的优点,为缺血性肌挛缩后遗僵硬性踝足畸形的外科治疗开辟了一条有效途径。

Mini-invasive distraction technique for treatment of severe ankle and foot deformities secondary to ischemic contracture of the leg

Objective To explore the llizarov mini-invasive distraction technique for the treatment of severer ankle and foot deformities secondary to ischemic contracture of the leg. Methods Based on the tension-stress low of llizarov, a serial of adjustable three dimensions external distractive instrument was developed in our department. From April 2002 to March 2004, 8 patients with ankle and foot deformities secondary to ischemic contracture of the leg induced by trauma and fracture were treated with the distractive instrument. Of them, 4 patient were male and 4 female, aged from 13 to31 years with an average of 23 years. Five affected legs were in the left and 3 in the right. Preoperative abnormal style included talipes equines in 6 feet and equinovarus in 2 feet, with extensive scar contracture in the legs. Five patients suffered from failure of soft tissue release before, two patients with severe bony deformity of the feet were underwent limited foot triple osteotomy in this department before the distractive correction. The distraction was begun from 7 d after operation and distractive time from 29 to 60 d with an average 46 d. Results All of the 8 patients were followed up from 10 months to 29 months, with an average of 13 months. All of deformities in the feet were corrected satisfactorily, full feet contacted with the ground in stand or walking and achieved with good function. No complication, such as pin tract infection, skin necrosis and neurovascular injury was occurred in this group. Conclusions Mini-invasive distraction technique for treatment of severe ankle and foot deformity secondary to ischemic contracture of the leg is safe and mini-injury, it is also an effective approach for the treatment of various kinds of rigid foot anomaly.