Ilizarov技术矫正儿童僵硬型马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正僵硬性马蹄内翻足畸形的方法和效果。[方法]作者在2000年3月～2005年3月间，使用Ilizarov技术矫正9例11足重度僵硬性马蹄内翻足畸形，将连接于胫骨、跟骨、跖骨的外固定环互相连接、组合成复杂的三维外固定架，通过逐渐调整外固定架矫正畸形，从而使患足达到或接近正常足的外形和功能。[结果]按Garceau标准评定疗效，优6足，良4足，差1足。[结论]Ilizarov外固定架三维矫正马蹄内翻足畸形效果确实，尤其适用于大年龄儿童之僵硬、复发或难治性马蹄内翻足，有一定的临床应用价值。     

手法松解配合塑质夹板外固定治疗马蹄内翻足

先天性马蹄内翻足是足部先天性畸形中最常见的疾病。自2003年至2007年采用手法按摩配合聚乙稀塑质夹板治疗1岁以内患儿单纯型马蹄内翻足78例113足，获得较满意效果，现报告如下。 1临床资料 1．1一般资料本组78例（113足），男48例，女30例；年龄15—321d，平均115d；单侧43例，双侧35例。出生后有明显畸形，但排除脑瘫、儿麻后遗症、全身关节挛缩症。     

手法按摩配合外固定治疗新生儿马蹄内翻足

自1990年10月-2002年10月应用手法按摩配合外固定治疗新生儿马蹄内翻足15例,效果良好,现报告如下。1临床资料本组15例,男11例,女4例;年龄最小6d,最大24d。单侧12例,双侧3例,共18足。僵硬型2例,松软型13例。临床表现:前足内收内翻10例,足跟内翻13例,踝与距下关节跖屈呈马蹄畸形15例。2治疗方法患儿仰卧位,术者用手指指腹按摩踝及足部挛缩的软组织,使其放松。首先一手抓住足跟,一手握前足使前足外展和外翻;其次一手抓住小腿,一手握住足跟向下拉并推足跟使之外翻;最后一手抓住小腿,一手抓足,前足外展外翻、足跟外翻,使踝及距下关节背伸纠正马蹄…     

1～11岁先天性马蹄内翻足治疗方法改进

介绍自行设计的外固定架治疗１－１１岁先天性马蹄内翻足的方法和效果。方法根据足的大小选用３套外固定架,固定准确穿过胫骨、跟骨、跖骨的３枚克氏针,通过调整固定架螺杆上的螺母逐渐矫正马蹄内翻足,使病足达到或接近正常足的外形和功能。结论该方法效果确定,有临床应用价值。     

环柄式外固定器在马蹄内外翻足截骨融合术中的应用

观察环柄式外固定器在马蹄内外翻足截骨融合术中的应用效果。方法２９例３６足行足附二关节、三关节截骨融合术，并应用环柄式外固定器固定。结果随访２９例，随访时间９－３０个月，３６足全部骨性融合。３３足外观基本正常，恢复三点负重，步态平稳。优良率９１．７％。     

Ilizarov技术矫治复杂僵硬性马蹄内翻足

 目的 探讨Ilizarov技术矫治复杂僵硬性马蹄内翻足的临床疗效。方法 回顾性分析2005年7月至2011年7月28例（41足）僵硬性马蹄内翻足患者的病例,男18例（26足）,女10例（15足）;年龄3~45岁,平均15.3岁;左足8例,右足7例,双足13例。根据Diméglio畸形分级：Ⅲ级31足,Ⅳ级10足。23足采用有限软组织松解、18足配合有限截骨后均安装Ilizarov外固定牵伸器。比较术前及末次随访时踝关节跖屈及背伸角度、踝关节活动度、正侧位X线片上患足距跟角的变化。结果 28例患者均获得随访,随访时间5~38个月,平均25个月。术后外固定支架佩戴2~14个月,平均5.1个月;去除支架后所有患足均获跖行步态,外形接近正常,无足短缩。足背伸角度：术前-45.0°±12.0°,末次随访9.5°±5.5°;跖屈角度：术前67.0°±14.0°,末次随访45.5°±7.8°;正、侧位X线片距跟角：术前分别为6.5°±4.5°和5.5°±11.0°,末次随访分别为22.5°±5.5°和40.6°±8.5°。1足术后发生急性血管痉挛性缺血,予减缓牵伸速度后缓解;5足发生针道感染,予更换针道及换药后感染控制。去支架后3个月,1足出现畸形复发,予二次矫形;3足畸形残留,5足趾屈曲挛缩,均给予二次软组织矫形术,未再复发。结论 Ilizarov技术矫治复杂僵硬性马蹄内翻足疗效确切,能最大程度保留足外形和功能,避免足短缩,不影响足发育。     

Ilizarov技术治疗成人马蹄内翻足畸形疗效观察

目的观察Ilizarov(伊里扎洛夫)技术矫正成人马蹄内翻足畸形的疗效。方法收治成人马蹄内翻足畸形31例全部采用Ilizarov技术矫正。结果 31例术后跟踪随访,其负重行走功能满意,未见足部各种畸形复发。根据Garceau标准评分系统:优26例,良5例。结论 Ilizarov技术治疗成人各种马蹄内翻足畸形,仅需微创小切口,避免多次复杂手术,可有效防止因一次手术不理想而进行的多次矫形手术。     

外固定架在先天马蹄内翻足矫形中的应用

目的用自制外固定架取代石膏固定患肢,治疗先天马蹄内翻足。方法对10例14足先天马蹄内翻足矫形术后用自制简易外固定架固定。结果优:8例,12足;良:1例,1足;可:1例,1足。优良率92.9%。结论自制简易外固定架固定可靠,操作简单方便,有效防止胫前肌止点移位后脱落和回缩的发生。     

Ilizarov外固定器治疗股骨颈骨折

我们自1993年9月以来，应用Ilizarov外固定器治疗内收型股骨颈骨折14例，效果良好，现报告如下。临床资料本组14例中，男6例，女8例；年龄32～67岁；受伤时间2小时至8天，平均4．3天；右侧9例，左侧5例，均为闭合内收型股骨颈骨折，有不同程度移位，无合并其它损伤。治疗方法本组14例均采用Ilizarov外固定器治疗，其操作方法：分别于患侧髂前上棘、股骨干中段及下段以2枚克氏外交叉固定组成三组Ilizarov环，并连接为一体；调整螺丝使股骨逐渐外展下移，在床边X光监视下使骨折接近于解剖复位；然后在X光监视下于股骨大粗隆下向股骨头交叉闭…     

单侧可调式外固定器治疗骨折的护理

］．②中期（术后３～４周）。除继续早期活动外，下肢骨折者开始练习双手抓秋千拉手或撑床坐起，以健肢着床，两手支撑抬臀，工作人员一手固定骨折段，一手抬起患肢小腿，使膝关节活动数次。鼓励并协助病人扶双拐下床练习行走，如下肢外固定下床，应有人搀扶，防摔倒。③后期（４周后）。软组织损伤基本恢复正常骨折端基本愈合，可进行全面功能锻炼，并增加活动次数及范围。２．２．６出院指导。坚持功能锻炼、谨防摔倒。３月（自固定日起）后拍Ｘ光片检查，如骨折完全愈合，可拆除外固定器，弃拐独立行走。３参考文献     

Ilizarov external fixator in treatment of severe recurrent congenital talipes equinovarus

Aim  

Severe recurrent congenital talipes equinovarus deformity remains a significant problem in orthopedic surgery particularly in the developing countries with limited facilities. Surgical treatment of patients with severe recurrent congenital talipes equinovarus is difficult and has many complications. This study discusses the results of using Ilizarov external fixator in treatment of severe recurrent congenital talipes equinovarus deformity.     

微型三维万向外用骨支架治疗婴幼儿先天性马蹄内翻足

2005年1月-2009年1月,我科应用微型三维万向外用骨支架治疗婴幼儿先天性马蹄内翻足20例,效果良好。1材料与方法1.1病例资料本组20例（35足）,男15例,女5例,年龄7个月-3岁,其中7个月-1岁9例,1岁1个月-2岁7例,2岁1个月-3岁4例。     

应用Ilizarov技术治疗青少年重度马蹄内翻足

目的 :探索青少年重度马蹄内翻足的治疗方法。方法 :应用足踝部有限软组织松解 ,结合术后外固定器缓慢牵伸松解关节挛缩 ,以及二期关节融合与肌力平衡手术治疗青少年重度马蹄内翻足 10例 (16足 )。结果 :16足均获得满意的畸形矫正及足底持重 ,3例遗有轻度前足内收。结论 :应用Ilizarov技术结合有限的手术治疗 ,可获得青少年重度马蹄内翻足的良好畸形矫正和功能恢复。     

Forearm lengthening using Ilizarov external fixator

Background

We present our experience with forearm lengthening using Ilizarov external fixator in cases of length discrepancies between radius and ulna and forearm–wrist deformity that occurred duo to different causes.

Methods

Twelve patients were treated by Ilizarov external fixator between 2008 and 2010 with a mean age of 10 years. There were seven males and five females. The etiology was Madelung’s deformity in seven patients, multiple cartilaginous exostosis in three patients, post-traumatic growth arrest of distal radius epiphysis in one patient, and chronic osteomyelitis of radius in one patient. The length discrepancy ranged from 1 to 4 cm (mean 2.2 cm). Lengthening of radius was done in nine patients and lengthening of ulna in three patients. The mean of follow-up period was 2 years.

Results

At follow-up, all patients were satisfied with the functional and cosmetic results. There was an improvement in pain and range of motion .The mean length gained was 2.2 cm and the mean healing index was 43.7 days/cm.

Conclusions

Lengthening of short forearm is functionally, cosmetically, and psychologically beneficial. The Ilizarov method is a reliable, successful, and safe method, and it is the gold standard to treat forearm length discrepancy and deformity problems preserving a satisfactory function of upper limb during treatment.     

Correction of neglected clubfoot using the Ilizarov external fixator

BACKGROUND: This study was conducted to evaluate the corrective capability of the Ilizarov external fixator in the treatment of neglected clubfoot. METHODS: Thirty patients (38 feet) with a mean age of 19 (5 to 39) years with severe deformities and stiff feet associated with neglected clubfoot were studied. A limited soft-tissue dissection, Achilles tenotomy, and plantar fasciotomy were done. Progressive correction of the deformities was achieved through a standard setting of the Ilizarov external fixator. The device was used for 16 weeks, on average, and after removal a short-leg walking cast was used for an additional 6 weeks, followed by an ankle-foot orthosis (AFO) for 6 months. RESULTS: The final outcome was scored as good (complete correction and no pain); fair (partial correction with plantigrade foot and occasional pain); or poor (nonplantigrade foot and continuous pain during walking). After a mean followup of 58 (range 12 to 107) months, the results were good in 30 feet (78.9%); fair in three feet (7.9%); and poor in five feet (13.2%). Early complications were a distal tibial fracture in one foot, dislocation of the first metatarsophalangeal joint in one foot, and arterial damage that resulted in amputation of the toes in one foot. Recurrence of the deformity was found in 19 feet (50%): 11 minor, three mild, and five severe. Spontaneous ankylosis developed in 28 feet (73.7%). Nine feet (23.7%) required arthrodesis for symptomatic arthritis of the ankle or midfoot and deformity that could not be treated with orthoses. CONCLUSION: The Ilizarov external fixator allows simultaneous correction of all the severe foot deformities associated with neglected clubfoot with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding excessive shortening of the foot. Even in those patients in whom final corrective arthrodesis is necessary, this may be carried out with minimal bone resection, since the severe deformities of the foot and ankle have been corrected.     

改良Ilizarov技术结合有限手术矫正马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正马蹄内翻足畸形的手术方法及器械改良、术后管理方法的改进及疗效。[方法]2003年1月～2006年5月，根据Ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循Ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7d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，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。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，治疗期间允许患足负重行走。术后平均牵伸42d，拆外固定器后患足再上石膏固定适当时间。[结论]32例患者术后均获得随访，其中26例为来院复查。随访时间1年～3年1个月，平均1年5个月。畸形均获满意矫正，足持重行走功能良好，患者满意。本组无1例发生严重针道感染和切口感染，未并发踝关节脱位及血管、神经损伤等并发症。[结论]改良Ilizarov技术矫正马蹄内翻足畸形，手术创伤小、安全，治疗效果提高，配合有限矫形手术，能够矫正传统矫形手术难以治疗的严重足畸形，缩短治疗周期，避免了严重手术并发症。