新疆喀什地区维吾尔族先天性马蹄内翻足流行病学调查报告

目的:了解新疆喀什地区维吾尔族中先天性马蹄内翻足的流行病学特征.方法:对该地区356 425名维吾尔族人进行了普查.并对10O例患者进行了1:4对照的病因学研究.结果:该地区CCF发病率为0.83‰,男:女为3:1,双足占57.58%.家族史(OR167)、孕期服药(OR104)、父母血亲(OR72)是CCF发病的主要因素,而父母烟酒史、食用土盐、无孕期保健、出生胎次等因素与对照组无明显差别.遗传度为92.86%,有CCF患者的家族其他人员的发病率为4.01%,家庭中CCF患者的同胞发病率为15.69%.结论:该地区维吾尔族人CCF发病率明显高于纯东方人,而非多基因遗传.     

后内侧松解治疗小儿先天性马蹄内翻足

自１９９０年３月～１９９４年１０月，我们采用后内侧松解为主加克氏针固定术治疗小儿先天性马蹄内翻足１７例２６足，取得良好效果，报告如下。１临床资料本组男１４例，女３例。双足９例，右５足，左３足，共２６足。年龄６月～７岁，术前石膏矫正２～７月，平均３．６...     

儿童创伤性马蹄足治疗中若干问题探讨

儿童创伤性马蹄足治疗中若干问题探讨傅跃先张德文向代理创伤性马蹄足系小腿以下或足踝部严重创伤的后遗畸形，儿童发生率较高，临床处理较为棘手．为了选择既能完全矫正马蹄足，又能满意修复创面的手术方法，改进治疗效果，１９９２年以来，笔者以Ｍｃｋａｙ手术加隐动脉...     

Ilizarov技术矫正儿童骨骺损伤后踝内翻畸形

儿童踝骨骺损伤后容易遗留踝内翻畸形,导致疼痛、肢体不等长、创伤性关节炎发生。通过微创截骨,根据旋转成角中心(CORA)原则使用Ilizarov环形外固定矫正,能够获得满意的力线和肢体长度,同时能处理其邻近骨、关节和软组织的病变,治疗后踝的外形和功能都非常满意。使用Ilizarov技术矫正此类畸形,可控性好、创伤小、并发症少。     

重度先天性马蹄内翻足外科治疗及远期疗效观察

先天性马蹄内翻足是常见的畸形,早期发现早期治疗都能收到较好的效果〔１〕。学龄前僵硬型的外科治疗已另有报道〔２〕。晚发重度由于畸形重,骨与软组织变形严重,一次矫正困难。我院自１９７２年以来采用软组织松解,保留距骨血供距骨嵌入三关节融合一次矫正畸形,减少...     

超声诊断胎儿法乐四联症伴马蹄内翻足1例

1　病例简介孕妇 2 5岁 ,第 1胎 ,孕 3 2周来院常规检查。Ｂ超示 :胎位ＲＯＡ ,胎心胎动可及 ,双顶径 8 0ｃｍ ,股骨长 5 8ｃｍ ,胎盘附着左前壁 ,Ｇｒ Ⅰ级 ,羊水平均深度 3～ 4ｃｍ ;胎儿心脏室间隔膜周部连续中断 0 5ｃｍ ,升主动脉直径 0 8ｃｍ ,骑跨于室间隔上 ,骑跨率 5 0 % (图 1) ,肺动脉主干直径 0 4ｃｍ ,ＣＤＦＩ示心室收缩期左右心室血液同时注入主动脉 ;胎儿双足交叉 ,足底平面与小腿冠状面在同一切面显示 (图 2 )。超声提示 :胎儿先心—法乐四联症 ,双足内翻。经引产后证实。图 1　主动脉骑跨于室间隔上。　图 2　足内翻…     

先天马蹄内翻足早期手术治疗

先天马蹄内翻足是常见畸形,发生率在1—3‰左右,男多于女,病因未能得到统一看法,治疗比较困难。以往早期常以非手术治疗为主,疗程长,复发率高。晚期畸形重,给生活带来极大不便,往往需要骨性手术解决问题。故近年来国内外许多学者主张     

有限矫形手术联合Ilizarov外固定架治疗青少年马蹄内翻足畸形的疗效观察

目的 探讨Ilizarov外固定架辅助有限矫形术在青少年马蹄内翻足畸形中的应用价值.方法 将2016年3月～2019年6月收治的青少年马蹄内翻足畸形80例,采用信封法进行分组,分为研究组和对照组,每组患者40例,两组患者均采用有限矫形手术,在此基础上研究组患者采用Ilizarov外固定架治疗,比较两组患者手术效果、国际...     

Ilizarov短缩加压、再延长骨搬移术治疗创伤性股骨干骨缺损

目的:探讨Ilizarov短缩加压+再延长骨搬移术治疗创伤性股骨干骨缺损的临床疗效。方法:采用回顾性病例系列研究分析2015年9月至2019年9月四川大学华西医院骨科收治的52例创伤性股骨干骨缺损患者临床资料,其中男32例,女20例;年龄19～60岁［（40.3 ± 12.1）岁］。股骨干骨折部位：近1/3段15例,中...     

应用潘塞提技术治疗先天性马蹄内翻足18例体会

马蹄内翻足是儿童骨科最常见的先天性残疾病症之一。据统计,每1000个新生儿中就有1例,即发病率为1‰,全球每年有超过100000先天性马蹄内翻足患儿出生,80％在发展中国家,其中多数得不到治疗或治疗不当。作者自2007年以来应用潘塞提（Ponseti）技术治疗先天性马蹄内翻足收效满意,现总结报道如下。     

Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效

目的 探讨Ilizarov骨搬运技术结合载万古霉素骨水泥垫块在胫骨创伤后骨感染合并骨与软组织缺损中的疗效.方法 采用回顾性病例系列研究分析2016年6月至2019年6月安徽医科大学第一附属医院收治的11例胫骨创伤后骨感染合并骨与软组织缺损患者临床资料,其中男7例,女4例;年龄21 ～56岁[(41.5±12.1)岁]....     

Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损

目的 探讨Ilizarov技术Ⅰ期治疗胫骨大段骨缺损合并软组织缺损的可行性.方法 2003年9月-2010年9月收治胫骨大段骨缺损合并软组织缺损患者24例,均为胫骨开放性骨折(Gustilo Ⅲ B型20例,Gustilo Ⅲ C型4例).在患肢上安放Ilizarov外固定架.清创术后小腿胫前内侧软组织缺损10 cm×6 cm,胫骨骨缺损(8±4)cm.对15例胫骨骨缺损＜5 cm的患者使用Ⅰ期清创、腓骨截骨、胫骨缺损端加压.对9例胫骨缺损＞5 cm的患者采用Ⅰ期清创、骨运输-骨延长.对15例患者采用Ⅰ期清创,封闭创面或缩小创面、骨搬移,Ⅱ期清理皮肤嵌顿及清理骨折端.结果 所有患者随访10～24个月,平均14个月.骨缺损均得以重建,患肢肢体长度与健侧之差＜2 cm,骨折愈合,创面均闭合.1例术后出现腓总神经麻痹,术后3个月恢复.19例未通过额外手术进行修复.3例通过游离皮片植皮成活,2例通过局部旋转皮瓣修复覆盖创面.结论 Ⅰ期使用Ilizarov外固定架进行骨搬移肢体是治疗胫骨骨缺损合并软组织缺损的有效方法.     

联合 Ilizarov 及 VSD 技术治疗合并软组织缺损的胫骨干骨缺损

目的：探讨Ilizarov技术及VSD技术联合使用在治疗合并软组织缺损的胫骨干骨缺损中的临床应用效果。方法选择2011年2月～2014年7月收治的合并软组织缺损的胫骨干骨缺损患者28例,男性18例,女性10例;年龄13～62岁,平均37.6岁。骨缺损长度2.5～10.8cm,平均6.7cm,软组织缺损面积（1.5cm ×3.5cm～4.5cm ×8.8cm,平均2.7cm ×6.4cm）。一期清创,清除感染及粉碎严重的骨质,胫骨干骺端截骨,安装Ilizarov外固定架,VSD护创材料覆盖创面,术后1周行皮肤及骨组织同时推移。结果所有患者随访5～23个月,平均15个月。骨缺损均得以重建并骨性愈合,患侧肢体长度与健侧之差＜1.5cm,创面均愈合。外固定指数1.3～2.5个月／cm,平均2.05个月／cm。结论联合Ilizarov及VSD技术治疗合并软组织缺损的胫骨干骨缺损疗效满意,实现了骨与软组织缺损的同期治疗。     

Ilizarov外固定行复杂踝融合

踝关节损伤的终末期修复重建主要是融合和置换。踝置换的远期效果不肯定,踝融合是解决的主要手段。复杂情况下的踝融合如果使用常规内固定方法,则其成功率低,同时不能解决缺损、畸形、感染等问题。使用Ilizarov技术则可以一并解决这些问题。     

Usefulness of an acoustic edge artifact in assessment of the Ilizarov corticotomy interval

Thirty-three ultrasound examinations of the corticotomy interval of patients undergoing Ilizarov procedures were retrospectively evaluated for the presence or absence of an acoustic edge artifact. This artifact, consisting of a fine anechoic band, has been previously described in phantom models and is presumed to be due to phase cancellation effects. We demonstrated this artifact in 8 of 33 examinations. The artifact proved helpful in identifying the location of the corticotomy margin, even when this margin was obscured by the presence of developing periosteal new bone. Attention to technical factors is, however, important. We believe that this artifact may have a useful role in the routine monitoring of the Ilizarov patient.     

Quantitative assessment of mineralization in distraction osteogenesis

OBJECTIVES: The most important decision in distraction osteogenesis is the timing of fixator removal. Various methods have been tried, such as radiographic appearance of callus and bone mineral density (BMD) assessment, but none has acquired gold standard status. The purpose of this study was to develop another objective method of assessment of callus stiffness to help clinicians in taking the most important decision of when to remove the fixator. MATERIALS AND METHODS: We made a retrospective study of 70 patients to compare the BMD ratio and pixel value ratio. These ratios were calculated at the time of fixator removal, and Pearson's coefficient of correlation was used to show the comparability. Inter- and intra-observer variability of the new method was also tested. RESULTS: Good correlation was found between BMD ratio and pixel value ratio, with a Pearson's coefficient of correlation of 0.79. The interobserver variability was also low, with high intra-observer reproducibility, suggesting that this test was simple to perform. CONCLUSION: Pixel value ratio is a good method for assessing callus stiffness, and it can be used to judge the timing of fixator removal.     

Sonographic evaluation of bone production at the distraction site in Ilizarov limb-lengthening procedures

The success of the Ilizarov distraction technique has resulted in a marked increase in the number of limb-lengthening and limb-straightening procedures performed for the correction of short and deformed limbs. This technique involves fracture of the bone and application of an external ring and bar support frame with circumferential screw threads and nuts, which allows systematic distraction of bone segments at a rate of 0.25 mm four times a day. During the procedure, the patient is encouraged to be ambulatory, as the strength of the frame allows weight bearing. Because of the limitations of plain radiographs in detecting the small amounts of new bone formation that occur at the distraction site in the early stages of healing, the success of the procedure cannot be determined for many weeks. The rate of distraction depends on the successful production of new bone in the distraction site. Early evaluation of new bone production is therefore important, because slow bone formation requires a decrease in distraction rate and vice versa. We examined 12 patients who had limb-lengthening procedures via the Ilizarov technique to determine if sonography could be used to detect early new bone formation at the distraction site. Our results show that new bone formation could be detected with sonography many weeks before its appearance on the radiograph. The sonographic appearance of new bone consists of echogenic foci within the distraction site, which become aligned in the longitudinal plane and which increase in number and size until they coalesce as echodense bone, which does not allow through-transmission of the ultrasound beam. In addition, sonograms showed 1.5-cm and 2-cm cysts within the distraction site in two patients in whom they were not visible on the radiographs. Timely percutaneous aspiration allowed continued normal bone generation. We conclude that sonography is useful for the detection of new bone formation at the distraction site in patients undergoing the Ilizarov procedure.     

Classification of equinus in ambulatory children with cerebral palsy-discrimination between dynamic tightness and fixed contracture

In this study a generalised dynamic neural network (GDNN) was designed to process gait analysis parameters to evaluate equinus deformity in ambulatory children with cerebral palsy. The aim was to differentiate dynamic calf muscle tightness from fixed muscle contracture. Patients underwent clinical examination and had instrumented gait analysis before evaluating their equinus under anaesthesia and muscle relaxation at the time of surgery to improve gait. The performance of the clinical examination, the subjective interpretation of gait analysis results, and the application of the neural network to assess ankle function were compared to the examination under anaesthesia. Evaluation of equinus by a Neural Network showed high sensitivity and specificity values with a likelihood ratio of +14.63. The results indicate that dynamic calf muscle tightness can be differentiated from fixed calf muscle contracture with considerable precision that might facilitate clinical decision-making.     

小儿脑发育的低场强磁共振成像技术研究

目的：优选适合发育期小儿脑的低场强MR扫描序列。方法：测量半卵圆中心灰、白质的T2值，观察T2值随月龄的变化。采用3种长TR序列[（1）常规TR2700ms,TE40、80ms;（2）中等长TR4000ms,TE40、80ms；（3）特长TR5000－8000ms,TE40、80ms]对各年龄组小儿进行检查，对各T2WI质量加以对比分析。结果：T2值的变化与髓鞘形成过程一致；新生儿期应选择特长TR序列，婴儿期应选择中等长TR序列，14个月以后可选常规TR序列。结论：在观察新生儿、婴儿期脑室及脑外间隙时，长TR图像优于TR图像。