Plantarflexion opening wedge medial cuneiform osteotomy for correction of fixed forefoot varus associated with flatfoot deformity

BACKGROUND: Flatfoot presents as a wide spectrum of foot deformities that include varying degrees of hindfoot valgus, forefoot abduction, and forefoot varus. Medial displacement calcaneal osteotomy, lateral column lengthening, and subtalar fusion can correct heel valgus, but may not adequately correct the fixed forefoot varus component. The purpose of this study was to determine the effectiveness of plantarflexion opening wedge medial cuneiform (Cotton) osteotomy in the correction of forefoot varus. METHODS: Sixteen feet (15 patients) had plantarflexion opening wedge medial cuneiform osteotomies to correct forefoot varus associated with flatfoot deformities from several etiologies, including congenital flatfoot (six feet, average age 37 years), tarsal coalition (five feet, average age 15 years), overcorrected clubfoot deformity (two feet, ages 17 years and 18 years), skewfoot (one foot, age 15 years), chronic posterior tibial tendon insufficiency (one foot, 41 years), and rheumatoid arthritis (one foot, age 56 years). RESULTS: Standing radiographs showed an average improvement in the anterior-posterior talo-first metatarsal angle of 7 degrees (9 degrees preoperative, 2 degrees postoperative). The talonavicular coverage angle improved an average of 15 degrees (20 degrees preoperative, 5 degrees postoperative). The lateral talo-first metatarsal angle improved an average of 14 degrees (-13 degrees preoperative, 1 degree postoperative). Correcting for radiographic magnification, the distance from the mid-medial cuneiform to the floor on the lateral radiograph averaged 40 mm preoperatively and 47 mm postoperatively (average improvement 7 mm). All patients at followup described mild to no pain with ambulation. There were no nonunions or malunions. CONCLUSIONS: Opening wedge medial cuneiform osteotomy is an important adjunctive procedure to correct the forefoot varus component of a flatfoot deformity. Advantages of this technique in comparison to first tarsometatarsal arthrodesis include predictable union, preservation of first ray mobility, and the ability to easily vary the amount of correction. Because of the variety of hindfoot procedures done in these patients, the degree of hindfoot correction contributed by the cuneiform osteotomy alone could not be determined. We have had excellent results without major complications using this technique.     

Hallux valgus repair. DuVries modified McBride procedure

The DuVries modification of the McBride procedure was investigated in 72 feet in 47 patients with hallux valgus deformity. Overall, the patient satisfaction rate was 92%. The hallux valgus averaged 32 degrees preoperatively, and 16 degrees postoperatively. The intermetatarsal angle averaged 14 degrees preoperatively and 9 degrees postoperatively. Anatomic realignment of the remaining tibial sesamoid was achieved in 28% of the feet. As a result of realignment of the first metatarsophalangeal joint, the intractable plantar keratosis beneath the second metatarsal head was resolved in 19 of 20 feet. Six patients developed a hallux varus deformity that averaged 7.5 degrees. All cases of hallux varus had medial displacement of the tibial sesamoid. The number of patients who could withstand unrestricted shoe wear increased from ten patients preoperatively to 30 patients postoperatively. The patient activity level increased in two thirds of the cases. The distal soft-tissue procedure produces the most predictable correction in patients with a hallux valgus deformity measuring less than 30 degrees. In more severe deformities, a proximal metatarsal osteotomy should be added to the procedure.     

Infantile tibia vara: Treatment of Langenskiold stage IV

An eight year old girl presented with a progressively increasing deformity of the left proximal tibia since last 2 years. She had no history of trauma, fever and swelling of left knee. There were no obvious signs of rickets/muscular dystrophy. She had 25 degrees of tibia vara clinically with lateral thrust and a prominent fibular head. The radiograph of left knee revealed tibia vara with medial beaking and a significant depression of the medial tibial epiphysis and metaphysis. A computed tomography (CT) scan revealed significant depression of the medial tibial epiphysis but no bony bar in the physis or fusion of the medical tibial epiphysis. There was a posterior slope in addition to the medial one. She was treated with elevation of the medial tibial hemiplateau with subtuberosity valgus derotation dome osteotomy. She also underwent a lateral proximal tibial hemiphysiodesis (temporary stapling). A prophylactic subcutaneons anterolateral compartment fasciotomy was also performed. All osteotomies united in 2 months. All deformities were corrected and she regained a knee range of 0 to 130 degrees. At final followup (4 years), there was no recurrence of varus deformity, knee was stable, with 1cm of leg length discrepancy. In Langenskiold stage IV tibia vara, elevation of medial tibial plateau, a subtuberosity valgus derotation osteotomy and a concomitant lateral hemiephiphysiodesis has given good results.     

The chevron osteotomy for correction of hallux valgus

Introduction The chevron osteotomy has become widely accepted for correction of mild and moderate hallux valgus deformities. The purpose of this study was to present the evolution of the chevron osteotomy at one institution over a period of 12 years. Methods Between April, 1991 and September, 1992, fifty-two consecutive patients with mild to moderate hallux valgus deformity underwent sixty-six distal chevron osteotomies at our institution. This was followed by 85 patients with 100 feet in the period from 1992 to 1995 and a group of 45 patients with 55 feet from 1994 to 1995. The final patient group included 61 patients with 89 feet operated from 2000 to 2002. Conclusion The chevron osteotomy is a reliable technique to correct hallux valgus deformities. Our recommendation after reviewing the results of the various modifications of the chevron technique revealed that the addition of a lateral release and a screw fixation will lead to the most reliable results.     

Shortening Proximal Chevron Metatarsal Osteotomy for Patients With a Hallux Valgus Deformity With Advanced Arthritis

To correct hallux valgus deformities in patients with advanced arthritis of the first metatarsophalangeal joint, we designed a new reverse chevron-type shortening osteotomy technique that could be used to correct valgus deformities at the proximal metatarsal level, as well as shorten and lower the metatarsal, in a 1-time procedure. Sixteen feet in 16 patients with a minimum of 18 months follow-up who underwent a shortening proximal chevron metatarsal osteotomy for a hallux valgus deformity with advanced arthritic change between January 2014 and March 2016 were reviewed in this study. Double chevron osteotomies with 20° of plantar-ward obliquity at the proximal metatarsal level were made at 5-mm intervals for simultaneous valgus correction and metatarsal shortening. An additional Weil osteotomy of the second metatarsal was performed in all feet. Patients’ mean age was 57.88 ± 6.55 years. The deformity was satisfactorily corrected by the operation. The first metatarsal was shortened by approximately 8.75 mm, and the relative length of the second metatarsal did not differ significantly postoperatively (p?=?.179). The relative second metatarsal height, as seen on forefoot axial radiographs, was maintained constantly, with no significant difference (p?=?.215). No painful plantar callosity or transfer metatarsalgia under the second metatarsal head was observed postoperatively. A shortening proximal chevron metatarsal osteotomy for hallux valgus deformities with advanced arthritic change showed a good result with respect to deformity correction and pain relief. Appropriate lowering and an additional Weil osteotomy effectively prevented postoperative pain and painful callosity under the second metatarsal head.     

Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy

In a long-term follow-up study (average, 10.7 years) of 222 patients (351 feet), the results after proximal phalangeal osteotomy (the Akin procedure) for hallux valgus deformity were found to be unsatisfactory, both subjectively and objectively. The range of motion in the metatarsophalangeal joint was limited postoperatively in 90 per cent of the patients, and in 21 per cent there was recurrence of deformity. The appearance of the foot was poor in 75 per cent. Only 53 per cent of the patients expressed satisfaction with the result of the operation. There was a direct relationship between the development of subluxation or dislocation of the metatarsophalangeal joint and postoperative dissatisfaction of the patient. We concluded that the operation is biomechanically unsound because it does not address the principal mechanical factors that are responsible for the deformity: abnormal function of the adductor hallucis and the abnormal intermetatarsal angle. The Akin procedure is indicated only in combination with other operations that are designed to correct the two cited abnormalities.     

Comprehensive treatment of late-onset tibia vara

BACKGROUND: Late-onset tibia vara (Blount disease) can be difficult to treat because of frequent morbid obesity and associated deformities, including distal femoral varus, proximal tibial procurvatum, and distal tibial valgus, that contribute to lower extremity malalignment. We present a comprehensive approach that addresses all components of the deformity and allows restoration of the anatomic and mechanical axes. METHODS: Fifteen consecutive patients (nineteen lower extremities) with late-onset tibia vara were managed with this comprehensive approach. The mean age of the patients at the time of surgery was 14.9 years, and the mean weight was 113 kg. Standing anteroposterior and lateral radiographs were made preoperatively and at the time of the final follow-up. Preoperatively, the mean mechanical axis deviation was 108 mm, the mean lateral distal femoral angle was 95 degrees , and the mean mechanical medial proximal tibial angle was 71 degrees . In all nineteen extremities, the proximal tibial varus deformity was corrected by means of a valgus osteotomy and application of an Ilizarov ring external fixator. Distal femoral varus was corrected by means of either hemiepiphyseal stapling or valgus osteotomy with blade-plate fixation in thirteen of the nineteen extremities. Distal tibial valgus was treated either with hemiepiphyseal stapling or with varus osteotomy and gradual correction with use of the Ilizarov external fixator in eleven of the nineteen extremities. RESULTS: After a mean duration of follow-up of 5.0 years, the mean mechanical axis deviation had improved to 1 mm (range, 20 to -30 mm), the lateral distal femoral angle had improved to 87 degrees (range, 83 degrees to 98 degrees), and the mechanical medial proximal tibial angle had improved to 88 degrees (range, 83 degrees to 98 degrees ). The mean time required for correction of the proximal tibial varus deformity was thirty-one days, and the external fixator was removed at a mean of 4.5 months postoperatively. All patients had development of one or more superficial pin-track infections (mean, 1.9 pin-site infections per patient). No wound infections, nonunions, or neurovascular complications occurred. Eighteen of the nineteen extremities were pain-free at the time of the final follow-up. CONCLUSIONS: This comprehensive approach allowed restoration of the mechanical and anatomic axes of the lower extremity in patients with late-onset tibia vara, resulting in a resolution of symptoms as a result of normalization of the weight-bearing forces across the knee and ankle. We believe that this approach will decrease the risk of early degenerative arthritis of the knee.     

Osteotomy of the tibia for correction of complex deformity.

Twenty complex tibial deformities due to anterior poliomyelitis in 18 patients were corrected by a modified O'Donoghue osteotomy. This technique allowed correction of the deformity in three planes. This was achieved by widening the rectangular window distally to correct both rotation and valgus and by trimming the anterior edges of the step cuts to correct flexion deformity. An above-knee cast was applied for eight to 13 weeks and the patients followed up for a mean of 3.2 years. One of the 18 patients developed delayed union because of fracture of the medial limb of the step cut. The results showed excellent correction of the three-plane deformity and there was no recurrence. This method of osteotomy is a safe and simple procedure which does not require internal fixation and allows correction of torsional and angular deformity.     

Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee

From 1960 through 1979, a closing-wedge varus osteotomy of the proximal part of the tibia was performed in thirty-one knees (twenty-eight patients) for painful osteoarthritis of the lateral compartment of the knee that was associated with a valgus deformity. The patients were followed for two to seventeen years (average, 9.4 years). Twenty-four knees (77 per cent) had either no pain or only occasional mild pain at the last evaluation. Six knees had moderate pain and one, severe pain. Six knees required a subsequent total knee arthroplasty at an average of 9.8 years after the osteotomy. No patient had an infection or non-union. Osteotomy of the proximal part of the tibia is a reasonable method of treating unicompartmental degenerative arthritis in a knee with a valgus deformity. Although some patients with as much as 20 degrees of anatomical valgus deformity obtained a good result in this series, osteotomy in the supracondylar region of the femur is probably preferable if the valgus angulation exceeds 12 degrees or if the tilt of the tibial articular surface that will result from the surgery will exceed 10 degrees. Correction beyond the normal 5 to 7 degrees of valgus angulation to zero degree of anatomical tibiofemoral alignment is recommended to prevent recurrence of the valgus deformity and to decrease the load on the lateral tibiofemoral compartment.     

Scarf and Weil osteotomies for correction of rheumatoid forefoot deformities: A review of 20 cases

The forefoot is commonly affected in rheumatoid arthritis. Little has been written of the results of metatarsophalangeal joint preservation in rheumatoid arthritis. We describe the results of the Scarf and Weil osteotomy for correction of forefoot deformities in patients with rheumatoid arthritis. Between 1996 and 1999, 17 patients (20 feet) underwent a Scarf osteotomy for their hallux valgus deformity and in 17 feet a Weil osteotomy of the lesser metatarsophalangeal joints. Radiographic examination was performed preoperatively and at a mean follow up of 65 months. A questionnaire was used at a minimum follow up of 6 years. The hallux valgus angle improved from 41° to 28° at follow up. The majority of the patients (79%) were satisfied with the result during follow-up. We found no wound infections, neuralgia or osteonecrosis of the first metatarsal. In three patients, a fusion of the first MTP joint was performed at follow up.In conclusion, the Scarf and Weil osteotomy is a useful method for MTP joint preserving surgery in rheumatoid forefoot deformities without severe impairment of the MTP joints.     

Spectrum of operative treatments and clinical outcomes for atraumatic osteoarthritis of the tarsometatarsal joints

BACKGROUND: The purpose of this study was to identify subtypes of atraumatic osteoarthritis of the tarsometatarsal joints based on accompanying foot deformities and to determine whether concurrent procedures done for each subtype were effective. METHODS: The study included 59 patients (67 feet) with atraumatic tarsometatarsal joint osteoarthritis treated with tarsometatarsal fusion. The average patient age was 60.2 years with 40.6 months followup. Patients were evaluated with radiographs, the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, the Foot Function Index, and the Short Form-36 Health Survey Questionnaire (SF-36). RESULTS: Four main subtypes were identified based on associated foot deformities: pes planovalgus (27), hallux valgus (11), in-situ without deformities (eight), and rockerbottom (five). Plantar-medial closing-wedge resection was used to correct rockerbottom deformity. For pes planovalgus deformity, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for tarsometatarsal osteoarthritis with severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Tarsometatarsal osteoarthritis with hallux valgus deformity was corrected with the Lapidus procedure. There were 29 complications, most commonly sesamoid pain. The pes planovalgus group showed significant radiographic improvements in four of five parameters measured. AOFAS scores improved from retrospectively assigned preoperative 34.1 points to postoperative 83.9 points. The Foot Function Index showed a high satisfaction rate (86.6%). SF-36 scores averaged 50.6 postoperatively. CONCLUSIONS: When feet with atraumatic tarsometatarsal osteoarthritis are classified into four main categories based on associated deformities, appropriate concurrent procedures can be done with high satisfaction and improved function scores. Pes planovalgus feet, in particular, may benefit from concurrent procedures with improved radiographic measures.     

Taylor空间支架矫正创伤后膝内、外翻畸形

  目的 探讨Taylor空间支架（Taylor Spatial Frame, TSF）矫正创伤后膝内、外翻畸形的临床疗效和精确度。方法 回顾性分析2006年6月至2010年12月,采用TSF矫正26例创伤后膝内、外翻畸形患者的病例,男19例,女7例;年龄19～62岁,平均39岁;创伤后膝内翻畸形20例,膝外翻畸形6例。21例行胫骨高位截骨,3例行股骨髁上截骨,2例同时行股骨髁上和胫骨高位截骨。安装TSF、测量支架的安装参数后截骨。术后7～10 d,根据电子处方,每天3次调节TSF支架上的可伸缩螺杆的长度,调节范围为0～3 mm。结果 经过7～35 d调节,20例畸形得到一次性完全矫正,患肢的胫骨、股骨力线恢复,肢体的成角、旋转和短缩畸形均得到矫正。6例尚残存轻微成角和短缩畸形,经第二次4～10 d的支架调整,畸形矫正。截骨处新骨生成和矿化良好,术后2.5～6.0个月去除外固定架。术后随访12～60个月,畸形无复发。术后11例发生针道感染,经应用敏感抗生素治疗,感染控制。1例去除外固定架后1.5个月发生股骨远端截骨处再骨折,经保守治疗骨折愈合。无一例患者发生血管神经损伤和继发性马蹄足畸形。结论 TSF矫正创伤后膝内、外翻畸形疗效确切,精确度高。     

A new surgical procedure for iatrogenic hallux varus: reverse transfer of the abductor hallucis tendon: a report of 7 cases

Iatrogenic hallux varus is a possible complication of hallux valgus surgery following Mc Bride or Scarf osteotomy, with or without Akin osteotomy of the first phalanx. It may also occur following chevron osteotomy or Keller's procedure. One possibility for surgical revision of iatrogenic hallux varus is reconstruction of the lateral stabilising soft-tissue components of the first metatarsophalangeal joint. Until now, only dynamic tendon transfers, possibly combined with interphalangeal fusion, have been described. The aim of our study was to develop a static, anatomic reconstruction procedure. A new surgical technique of ligamentoplasty using the abductor hallucis tendon is described. The new method was applied in 7 feet (5 patients) with a mean follow-up over two years. Hallux varus deformities were operated by transplantation of the abductor hallucis tendon. Subsequent radiographs showed correction of most of the factors considered to be responsible for the iatrogenic deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score improved from 61 to 88. This new technique is a reliable, anatomic reconstruction with use of the tendon involved in the pathogenesis of the hallux varus deformity. No other functional tendon is used.     

Double-elevating osteotomy for late-presenting infantile Blount's disease: the importance of concomitant lateral epiphysiodesis

We reviewed 34 knees in 24 children after a double-elevating osteotomy for late-presenting infantile Blount's disease. The mean age of patients was 9.1 years (7 to 13.5). All knees were in Langenski?ld stages IV to VI. The operative technique corrected the depression of the medial joint line by an elevating osteotomy, and the remaining tibial varus and internal torsion by an osteotomy just below the apophysis. In the more recent patients (19 knees), a proximal lateral tibial epiphysiodesis was performed at the same time. The mean pre-operative angle of depression of the medial tibial plateau of 49 degrees (40 degrees to 60 degrees ) was corrected to a mean of 26 degrees (20 degrees to 30 degrees ), which was maintained at follow-up. The femoral deformity was too small to warrant femoral osteotomy in any of our patients. The mean pre-operative mechanical varus of 30.6 degrees (14 degrees to 66 degrees ) was corrected to 0 degrees to 5 degrees of mechanical valgus in 29 knees. In five knees, there was an undercorrection of 2 degrees to 5 degrees of mechanical varus. At follow-up a further eight knees, in which lateral epiphysiodesis was delayed beyond five months, developed recurrent tibial varus associated with fusion of the medial proximal tibial physis.     

Scarf osteotomy in hallux valgus: a review of 72 cases

The Scarf osteotomy is now widely used for the correction of hallux valgus. The aim of our study was to evaluate the results after Scarf osteotomy considering patient's satisfaction as well as the clinical and radiological results. Between 1996 and 1999, 72 feet underwent a Scarf osteotomy of the first metatarsal and, in 11 feet, an additional Akin osteotomy of the proximal phalanx, for the correction of hallux valgus (55 patients: 49 female, 6 male; mean age: 52 years). The hallux valgus angle improved significantly, from 32 degrees preoperatively to 18 degrees at follow-up (minimal follow-up: 6 years; mean: 7.5 years). A second operation was necessary in two patients because of recurrence of hallux valgus, and a fusion of the first metatarsophalangeal joint was performed in two patients. At the time of latest follow-up 78% of the patients were satisfied or very satisfied with the result. The Scarf osteotomy combined with Akin's closing wedge osteotomy is a safe and effective procedure for the treatment of moderate hallux valgus deformities.     

High Tibial Osteotomy for Rheumatoid Arthritis of the Knee: A One to Six Year Follow-Up Study

Although high tibial osteotomy for osteoarthrosis of the knee joint is well recognized, its place in the management of rheumatoid arthritis of the knee is much less well established. Thirty-six rheumatoid knees were reviewed 1 to 6 years following tibial osteotomy. The results were 42 per cent good, 19 per cent satisfactory and 39 per cent poor. No patient remained free of pain for more than 3 years, and recurrence of pain was not always associated with recurrence of deformity. Varus knees did considerably better than valgus knees despite some technical errors. Maintenance of a normal femoro-tibial angle range of 164° to 177° at follow-up was important but not as vital as in osteoarthrosis of the knee. The beneficial effect of tibial osteotomy in rheumatoid arthritis of the knee seldom lasted more than 3 years after which time an increasing number of bad results were seen. It was concluded that high tibial osteotomy was a satisfactory procedure for rheumatoid arthritis of the knee but its efficacy was not comparable to that seen in osteoarthrosis nor was its effect long-lasting.     

Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy

Nineteen cases of osteoarthritis of the knee with valgus deformity in 17 patients were treated by femoral supracondylar varus osteotomy (17 cases) or by high tibial varus osteotomy (2 cases) over the last 15 years. Fixation was performed using a 95 degrees AO blade-plate in 13 of the femoral osteotomies and a straight plate in the other four. The mean follow-up time was 6.5 years. The valgus deformity was idiopathic in 14 cases, secondary to rheumatoid arthritis in 2 cases and to tibial valgus in one case. The Hospital for Special Surgery (HSS) score was used to evaluate the clinical results: nearly 75% were excellent or good. The causes related to poor results are analyzed regarding indication and surgical technique. It appears that varus osteotomy is an effective procedure for the treatment of osteoarthritis of the knee with valgus deformity, above all in order to alleviate pain, although the operation requires precision, and correct selection of patients is of prime importance.     

Failure of hallux MP preservation surgery for rheumatoid arthritis

Eight patients underwent surgery on 15 feet for rheumatoid forefoot problems. Thirteen of the 15 feet that were operated upon had an attempt to preserve the hallux metatarsophalangeal joint while resectional arthroplasty was performed on the lesser MP joints. All of the 13 feet that had the MP joint preserved had a well-preserved joint space preoperatively and no active signs of inflammation at the time of this procedure. Eight feet underwent a distal Chevron osteotomy to realign the great toe, two feet underwent an IP fusion as only the IP joint had evidence of erosive changes, and one foot underwent a combination of a Chevron osteotomy and a proximal phalangeal osteotomy (Akin procedure). Two patients had no surgery on their first ray as it was well aligned with no evidence of erosive changes. Of the 13 feet that did not have a fusion performed, 11 had development of a valgus deformity or inflammatory erosions. The average time to failure was 24 months (range, six to 36 months). The Chevron/Akin procedure remained successful at 18 months and one of the IP fusions was successful at six years after surgery. Although patients with rheumatoid forefoot disease may on occasion have a well-preserved hallux MP joint with minimal or no deformity and no active inflammation, with severe lesser toe involvement, most of these patients will fail a surgical procedure which does not involve fusion of the hallux MP joint.     

Results of Akin type proximal phalangeal osteotomy for correction of hallux valgus deformity

The results of 26 Akin proximal phalangeal osteotomies in 22 patients for hallux valgus deformities are reported. The average follow up was 53 months (range, 12 to 97 months). Subjectively, 16 feet had a satisfactory result (61.5%). Objectively, 14 feet met the criteria for a satisfactory result (53.8%). The authors found that the Akin osteotomy was unpredictable as an isolated procedure, and not indicated in a hallux valgus deformity with an incongruent joint.     

可调组合式下肢外固定支架的改良及临床应用

目的 介绍自制可调组合式下肢畸形外固定支架系列构型,探讨该装置的临床应用原则.方法 在Ilizamv环形外固定支架的基础上,根据国人下肢畸形矫正与重建的需要及便于医生穿针安装操作的要求,将组合式外固定支架的配件与 Ilizarov环形外固定支架结合,加入弹簧牵伸装置与螺纹半针固定技术,研制了管状骨微创截骨矫形的工具,并根据下肢残缺畸形的特点,术前预先设计组装好个体化矫形器械.自2004年1月至2010年12月,应用改良Ilizarov外固定矫形器治疗下肢畸形患者146例,男95例,女51倒;年龄3.6～61.0岁,平均33.4岁;髋部畸形18例,膝关节屈曲畸形49例,膝关节周围股骨外翻畸形10例,胫骨内翻畸形46例,胫骨骨缺损、骨不连伴复合畸形23例结果 患者术后获8 ～46个月(平均28.6个月)随访.139例下肢畸形获得矫正、下肢力线基本恢复,行走功能明显提高.1例患者术后截骨端出现位移,重新调整外固定支架后纠正;2例膝关节周围内外翻畸形尚残留10°～ 15°内翻;3例在骨延长过程中出现膝关节屈曲功能障碍.4例患者出现术后针道感染.髋部畸形按Harris评分标准:由术前(36.91±3.14)分提高为(86.25±2.26)分;49例膝关节屈膝畸形完全矫正;胫骨骨不连处及新生骨均愈合,功能基本恢复.结论 改良的下肢畸形外固定矫形支架具有Ilizarov环形外固定器的主要功能,可满足下肢多数畸形矫正、残缺修复与功能重建的需要,临床应用能达到预期治疗目标,适合在临床中进一步推广.