Ilizarov技术联合Ponseti方法治疗儿童僵硬性马蹄内翻足的临床研究

目的 探讨Ilizarov技术联合Ponseti方法治疗大龄儿童僵硬性马蹄内翻足畸形的临床疗效.方法 回顾性分析2012年7月至2016年7月玉林桂南医院收治的36例(49足)儿童僵硬性马蹄内翻足病例的临床资料,术前均行负重位踝关节正侧位X线检查,根据安装Ilizarov外固定架治疗前是否进行Ponseti石膏矫正分为...     

High recurrence after calf lengthening with the Ilizarov apparatus for treatment of spastic equinus foot deformity

Both gastrocnemius recession and Achilles tendon lengthening lead to scarring in the calf and have high reported recurrence rates when performed under the age of 8 years. Triceps surae lengthening by external fixation seemed to be a valuable alternative. Twelve calf lengthenings have been performed with an Ilizarov device with a mean correction of 27 degrees. No calcaneal gait was observed, but there was a slow continuous loss of dorsiflexion over the observation period. The Ilizarov technique has a higher recurrence rate than most operative procedures for calf lengthening, but carries virtually no risk in producing calcaneus. The technique cannot be recommended for routine clinical use and may only be an alternative for selected cases.     

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技术胫骨横向骨搬移术治疗糖尿病足

[目的]探讨应用Ilizarov技术胫骨横向骨搬移术治疗糖尿病足的临床疗效。[方法]2014年8月~2016年3月,采用Ilizarov技术胫骨横向骨搬移术治疗糖尿病足患者40例,男26例,女14例,年龄39~79岁,平均56.8岁;左侧22例,右侧18例,按Wagner分级,2级10例,3级22例,4级8例。[结果]40例患者均获得随访,随访时间4~19个月,平均11.5个月,患足均获得愈合(全部保肢),创面平均愈合时间12.6周,患肢疼痛及麻木症状改善甚至消失。[结论]胫骨横向骨搬移术能有效治疗糖尿病足,避免截肢。     

The Ilizarov apparatus for treatment of melorheostosis. Case report and review of the literature.

Traditional conservative and surgical methods of treatment of melorheostosis, such as manipulations, plaster casts, soft-tissue releases, capsulotomies, and osteotomies cause a high recurrence rate. In a 12-year-old girl, flexion contracture of a knee with limb inequality caused by melorheostosis was corrected successfully with the Ilizarov distraction apparatus.     

Correction of Madelung's deformity by the Ilizarov technique

We present our experience with correction of Madelung's deformity by the Ilizarov technique. Seven patients (eight deformities) were treated by osteotomy of the radius with subsequent lengthening and angular correction. They were reviewed at a mean of 30 months (1.5 to 5.5 years). At the time of operation their mean age was 19 years (9 to 44). At follow-up all were free from pain and supination had improved by a mean of 34 degrees and pronation by 9 degrees. Flexion had increased in most cases with a median increase of 15 degrees, but only one patient gained further extension. Radial and ulnar deviation were increased by a mean of 6 degrees and 9 degrees, respectively. Radiographic measurements showed that the mean volar angulation had been reduced from 25 degrees to 11 degrees, ulnar inclination from 45 degrees to 30 degrees and carpal malalignment (volar translation) from 7 to 2 mm. The mean lengthening of the radius was 12 mm (6 to 25). All the patients were satisfied with the functional and cosmetic results.     

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 principles of deformity correction

Ilizarov frames provide a versatile fixation system for the management of bony deformities, fractures and their complications. The frames give stability, soft tissue preservation, adjustability and functionality allowing bone to realise its full osteogenic potential. It is important that we have a clear and concise understanding of the Ilizarov principles of deformity correction to best make use of this fixation system. In this review article, the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use and the clinical use of the fixation system are discussed.     

足外伤术后复位不良致平足畸形1例

<正>患者,女,25岁,于2017年1月9日因车祸致右小腿出血、肿痛,右足皮肤擦伤,中足畸形、疼痛,右踝关节活动受限。X线片示右胫腓骨开放骨折,右足舟骨骨折、右距舟关节脱位(图1a,1b)。诊断为右小腿开放伤,右胫腓骨骨折,右足舟骨骨折,Chopart关节脱位。于急诊在神经阻滞麻醉下行右胫腓骨远端开放骨折清创缝合、骨折复位内固定术。术     

应用Ilizarov技术治疗先天性胫骨前弯畸形1例报告

先天性胫骨前弯畸形是婴幼儿骨科少见的疾病,它严重影响了患儿的功能和发育,不进行治疗可能引发骨折的危险。我们对1例先天性胫骨前弯畸形患儿进行了Ilizarov支架矫正治疗,经临床观察及长期随访,取得满意效果。     

右足蜡泪样骨病1例报告

患者，女，18岁，右足疼痛18年，右踝关节活动受限逐渐加重，活动后加重，休息后缓解。于2005年4月19日跛行人院。查体：右足马蹄样畸形，右足第4趾见环形束带，足趾缩短7mm，右踝关节背伸位强直，右小腿肌肉萎缩，患处皮肤发红略紧张，弹性差，质韧，皮肤温度略低，有轻压痛。X线：右第4趾骨、跖骨缩短，内密度增高，右足骰骨、跟骨及第3、5跖骨、第3中节趾骨见斑片状密度增高影，     

Nonsurgical treatment of adult acquired flat foot deformity

The adult acquired flat foot requires assessment with unique casting and fabrication of support appliances. Conservative treatment is preferred as the initial protocol. Stabilization and control of affected joints can provide the patient with a decreased level of pain and an increased level of function. The orthosis design must acceptable to the patient's lifestyle to ensure compliancy.     

Ilizarov技术治疗儿童下肢畸形

目的 介绍Ilizaro技术治疗儿童下肢畸形的临床经验。方法 采用Ilizaro技术治疗31例下肢畸形患儿，2例为先天性胫骨假关节以往植骨内固定治疗失败，4例为骨髓为后骨不连，植骨后短缩，11例为下肢短缩，8例为先天性马蹄内翻足，4例为下肢骨折，1例为骨纤维发育异常，1例为软骨发育不全性侏儒。结果 31例均达到预期目的。结论 应用Ilizaro技术可以在修复骨缺损的同时矫正肢体不等工，假关节切除后延长与加压可以同时进行。Ilizaro三维相结合可矫正足内翻下垂畸形。双下肢同步延长可治疗软骨发育不全性侏儒。     

The treatment of failed reconstruction for adult acquired flat foot deformity

The successful salvage of a failed reconstruction for adult acquired flat foot deformity requires a thorough assessment of the alignment, healing, and function of the entire foot. The pain that is experienced by the patient often emanates from multiple sources. Once identified, the plan of treatment must provide an integrated and comprehensive approach to resolve the origins of pain to restore durable function to the foot. Often, these goals may be achieved through the use of orthotics, physical therapy, and other nonoperative means. Additional or revision surgical procedures may be necessary to complete or correct the previous attempts to reconstruct the foot.     

Ilizarov外固定架治疗创伤性马蹄足

目的探讨应用Ilizarov外固定支架治疗创伤性马蹄足的疗效。方法2003年2月～2005年8月应用Ilizarov外固定架治疗17例创伤所致马蹄足患者。将组装好的Ilizarov外固定架按照Ilizarov的穿针固定原则安装在患侧小腿和足部。术后3d开始转动螺纹杆上的螺母,第1周旋转螺母2～4圈/d,4次/d;1周后旋转螺母1～2圈/d,4次/d,分别逐渐缩短和延长前、后螺纹杆,矫正马蹄足畸形。用伊氏架将踝关节固定在中立位2～3个月。去除外固定架后让患者逐渐增加负重量直至完全负重。不负重时穿戴支具保持踝关节处于中立位至少3个月。结果17例患者均得到随访,平均随访10个月(7～14个月)。术后4～6周踝关节恢复到中立位。平均带外固定架14.5周(10～16周)。无血管、神经损伤。3例各1处针道轻度感染,对症处理后感染消失。1例诉矫正过程中疼痛,术后10周去除外固定架,去除外固定架后6周时僵直在跖屈20°。1例去除外固定架4个月后僵直在跖屈10°。1例小腿前后肌群损伤严重合并胫骨骨缺损重建术后踝关节矫正到中立位后1.5个月行踝关节融合术,融合术后3个月去除外固定架。其余14例达到0°全足负重,行走时无明显足下垂。2例负重时疼痛。踝关节背伸肌群功能存在的患者,踝关节可主动背伸10°。结论Ilizarov外固定架是治疗创伤性马蹄足的微创技术。     

Ilizarov外固定架治疗痉挛型脑瘫屈膝畸形

目的：探讨应用软组织矫形加用Ilizarov外固定架矫治痉挛型脑瘫屈膝畸形的方法和疗效。方法：依据Ilizarov张力一应力法则及其应用技术，按个体化要求，安装Ilizarov外固定架，在外固定架屈侧设置2个铰链关节便于撑开，伸侧设置1个铰链关节便于加压。术后3～5d，待患者腿部疼痛、麻木感减轻后开始屈侧撑开，伸侧加压，每日屈侧延长2mm左右。定期检查克氏针的张力，以免固定松动。每2周摄X线片复查，根据目测观察膝关节矫正角度及X线表现及时修正延长、矫形方案。患者3-6周后膝关节角度就可完全矫正，在过伸10°置维持3周，即可拆除Ilizarov外固定架，活动膝关节，然后佩戴下肢伸直位支具行走2-3个月。2例因术前合并股骨下段前弓畸形，Ⅱ期实施股骨髁上截骨术矫正。结果：21例36个膝关节，术前屈膝畸形平均（80．61±25．51）°，矫正后屈曲角度平均（8．91±2．39）°。21例，36个关节平均随访5个月，其中32个关节维持牵伸术后的效果，4个关节屈膝畸形部分复发，平均（9．32±7．33）°。结论：正确使用Ilizarov技术矫治痉挛型脑瘫屈膝畸形，疗效满意，并发症少，是一种微创、安全、有效的治疗方法。     

Ilizarov 技术矫治马蹄足畸形中胫距关节前脱位的治疗及预防

 目的 总结 Ilizarov 技术矫治马蹄足畸形中发生胫距关节前脱位的概率、治疗及预防方法。方法 回顾性分析 2011 年 10 月至 2012 年 4 月,应用 Ilizarov 技术矫治 38 例马蹄足畸形患者资料,其中 5 例于术后 14～28 d 发生胫距关节前脱位,男 4 例,女 1 例;年龄 19～30 岁,平均 23.8 岁;均为马蹄内翻足畸形患者。5 例患者初次手术采用 Ilizarov 技术矫治马蹄足畸形,同时行经皮跟腱延长术、经皮跖腱膜切断术、胫后肌松解、胫前肌移位,其中 4 例同期行距骨周围截骨术,1 例同期行第一跖骨基底截骨术,1 例同期行胫骨近端去旋转截骨术;发生胫距关节前脱位后,1 例经手法复位,4 例使用 Ilizarov 复位装置后继续按原计划牵伸调整外固定架矫形,直至满意。结果 5 例马蹄内翻足畸形患者在行 Ilizarov 技术矫形过程中发生胫距关节前脱位的概率为 13.2%（5/38）。5 例患者均获得随访,随访时间 6～12 个月,平均 10 个月,马蹄足畸形均完全矫正。末次随访时应用国际马蹄足畸形研究学组评分为 3～10 分,平均 4.8 分;其中优 2 例,良 3 例,优良率为 100%。无一例发生钉道感染、神经血管损伤、血栓等并发症。结论 胫距关节脱位是 Ilizarov 技术矫治马蹄足畸形中较常见的并发症,发生率约为 13%。发生胫距关节前脱位后,及时安装距骨复位装置可获得良好效果。围手术期管理应注意外固定铰链关节与踝关节瞬时旋转中心的匹配。