改良Charnley关节夹在马蹄内外翻足截骨融合术中的应用

目的 观察改良Ｃｈａｒｎｌｅｙ关节夹在马蹄内外翻足截骨融合术中的应用效果。方法 采用改良Ｃｈａｒｎｌｅｙ关节夹固定足跗二关节，三关节截骨融合术治疗４５例５２足。结果 随访３９例４３足，随访时间１１个月￣７年３个月。平均３年５个月，４３足全部骨性融合，４２足外观基本正常，恢复三点负重，步态平稳。优良率９５％，结论 该方法操作简单，观察方便，效果满意。     

外固定架在三关节融合术中的应用

目的：应用外固定支架逐步矫正行三关节融合术，探讨其可行性。方法：本组６例６足，年龄１３岁－２５岁，均为足下垂角度大，且合并有血管及神经并发症。行三关截骨，用外支架逐步矫正达到三关节融合。结果；本组全部病例三关节融合良好。无１例出现血管及神经损伤严重并发症。１例行走时轻微疼痛，跛行。２例针孔少量渗出，拔针后愈合，无深部感染。     

Ilizarov外固定器治疗马蹄内翻足的护理

[目的]总结13例马蹄内翻足应用外固定器矫形的护理。[方法]采取心理疏导、针孔护理、密切观察肢体感觉、运动功能,指导正确使用外固定器及康复训练等综合护理。[结果]随访13例患者术后疗效满意,无1例因护理不当出现并发症。[结论]应用外固定器治疗,通过围手术期精心护理,保证了手术的成功,达到了病人的满意。     

截骨融合治疗严重僵硬性马蹄足畸形的临床疗效观察

目的 :探讨截骨融合术矫正严重僵硬性马蹄足畸形的临床疗效。方法 :自2010年4月至2015年10月,采用空心钉行截骨关节融合术矫正13例(16足)严重僵硬性马蹄足畸形患者,其中男6例,女7例;年龄39~62(49.6±5.3)岁;病程5~27(9.0±4.8)年。采用三关节截骨融合术6例(9足),四关节截骨融合术4例(4足),胫距跟关节截骨融合术3例(3足)。所有患者术前表现为患足疼痛、足跟不能接触地面、无法行走。观察患者术后并发症情况,并采用AOFAS评分进行临床疗效评定。结果:13例患者获得随访,时间18~24个月,平均20个月。术后仅有1例出现伤口部分皮肤坏死,予伤口换药、抗感染治疗后痊愈。末次随访时所有患足达到骨性愈合,时间12~16周,平均13.2周。AOFAS评分由术前的11.85±10.66提高至术后的81.38±3.69,差异有统计学意义(t=-25.67,P0.05);其中良15足,可1足。结论 :根据患者情况,可采用胫距跟关节融合、三关节或者四关节融合术矫正部分严重僵硬性马蹄足畸形,并可取得较满意的临床疗效。     

微创截骨外固定器固定治疗膝内翻畸形

[目的]探讨微创截骨矫形外固定器固定治疗膝内翻的效果。[方法]采用股骨髁上微创截骨矫形,外固定器固定治疗患者27例32膝。[结果]所有病例均一期骨性愈合,畸形矫正满意,畸形矫正度数为15°~33,°平均21°。身高增加1.6~3.1 cm,关节立线及膝关节功能均良好。[结论]微创截骨矫形单侧外固定器固定治疗成人膝内翻畸形具有创伤小、可控制性好、骨愈合快、并发症少等优点。     

转子下斜行截骨外固定器治疗成人髋内翻

我科 1996～ 2 0 0 0年收治 12例成人髋内翻 ,其中 5例合并肢体缩短 ,采用股骨转子下斜行截骨 ,单侧成角外固定架外展位固定 ,通过随访 ,效果满意。1　材料与方法1.1　病例资料 　本组 12例 ,男 9例 ,女3例 ,年龄 2 1～ 6 5岁。均为单髋。 8例并发于股骨转子间骨折 ,1例并发于股骨上端骨纤维异样增生症 ,3例为先天性髋内翻。术前颈干角 75°～ 10 0° ,平均87° ,其中 5例合并肢体不等长 ,相差 2～5ｃｍ ,平均 3ｃｍ。1.2　器械和方法1.2 1　手术设计　术前摄骨盆平片 ,了解健侧的颈干角 ,设计出手术所需要的角度 ,手术方法见图 1。图 1　…     

足三关节融合术畸形复发的原因与对策

目的：探讨足三关节融合术畸形复发的原因与对策。方法：对1979—2001年的801例(855足)三关节融合术进行了回顾性调查，对其中的19例畸形复发原因进行了分析，并提出应对措施。结果：本组19例畸形复发的病人均行再次手术，矫正足三关节的复发畸形。术后经3—10年的随访，全部病人行走无疼痛，外观基本正常。结论：重视肌力平衡问题，把握手术适应证和掌握截骨的要点是避免足三关节融合术畸形复发的重要环节。     

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。     

远端半针Ilizarov外固定器结合微创截骨术治疗膝内翻畸形

 目的 探讨远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形的临床疗效。方法 回顾性分析2002年2月至2010年5月收治的31例膝内翻畸形患者的病例,男8例,女23例;年龄18~69岁,平均35.6岁;单侧6例,双侧25例,共56膝。术前膝内翻角度为7.7°~38.2°,平均17.0°±8.8°。根据美国膝关节关节协会评分（knee society score, KSS）为34~100分,平均（86.2±18.5）分。确定成角旋转中心与截骨矫形的位置,在胫骨畸形交点处用微创截骨器截骨,腓骨在头下截骨。安装术前已组装好的Ilizarov外固定器,通过调整伸缩内、外侧支架螺杆的长度渐进矫正内翻畸形。采用X线检查及膝关节KSS临床评分,结合行走时自我感觉及有无并发症等4项内容综合评价临床疗效。结果 患者佩戴Ilizarov外固定器的时间为9~20周,平均12周;随访时间14~50.4个月,平均30.5个月。末次随访时膝内翻角度为-3°~2.4°,平均1.7°±0.9°;膝关节KSS评分为75~100分,平均（96.1±7.7）分,其中优49例,良6例,可1例,优良率为98.2%（55/56）。11例患者术后早期发生轻度针道感染,经常规换药后感染控制;3例术后发生针道松动,经更换针道后恢复固定强度。结论 远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形具有微创、安全、动态矫形及符合美学要求的特点,临床效果满意。     

骨外固定器在断肢再植中的应用

骨外固定器在断肢再植中的应用王利，朱通伯，罗经文，梁江山断肢再植术中骨支架的建立是再植成活及恢复良好功能重要的一环。要求固定简便迅速，确实稳固，使骨折愈合快和功能恢复好。１９９３年２月～１９９５年２月我们在断肢再植术中，应用骨外固定器固定骨骼，效果较...     

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。     

Knee arthrodesis with the Ilizarov external fixator as treatment for septic failure of knee arthroplasty

Background  

The authors report the results of femoral–tibial fusion with an Ilizarov circular external fixator following septic loosening of knee prosthesis.     

Triple arthrodesis with an external rail fixator: A review of 8 cases

The results of 8 patients who underwent triple arthrodesis with a rail external fixator were reviewed retrospectively. The frame construct allowed immediate axial loading and unrestricted ankle joint mobilization. Assistive ambulatory equipment was not required postoperatively. Periodic adjustment to compression was performed weekly until evidence of radiographic consolidation. The mean duration of frame application was 11.5 weeks. Follow-up averaged 15.9 months. Fusion occurred in all joints. One superficial pin-tract infection developed that resolved with oral antibiotics. The results of this study indicate that the rail frame system provides a viable fixation alternative for triple arthrodesis and warrants further investigation.     

Arthrodesis of the hip joint using an external fixator

Arthrodesis of the hip has been plagued by high rates of nonunion, and by complications associated with prolonged cast immobilization. To prevent these problems, we devised a procedure for hip arthrodesis using an external fixator in combination with internal fixation at the fusion site. We have treated nine patients with this technique. All of the arthrodeses were solidly united without wound infections at the most recent follow-up. Patients were able to leave their hospital bed and walk on the affected limb with a cane shortly after surgery. This was possible because the external fixator was low in profile, as it was applied from the anterosuperior iliac spine to the femoral shaft, and provided rigid stabilization of the arthrodesis. The technique resulted in a reduction in the period of bed rest, immediate postoperative mobilization, shorter periods of hospitalization, no limitation in the range of knee and ankle motion, improvement in the patient's ability to carry out the personal hygeine, and fewer complications. Received for publication on July 24, 1998; accepted on March 5, 1999     

Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot's neuroarthropathy

Background:

Charcot''s neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot''s neuroarthropathy has a high failure rate. This is a retrospective nonrandomized comparative study assessing the outcomes of tibio-talar arthrodesis for Charcot''s neuroarthropathy treated by uniplanar external fixation assisted by external immobilization or retrograde intramedullary interlocked nailing.

Materials and Methods:

Records of the authors′ institution were reviewed to identify those patients who had undergone ankle fusion for diabetic neuroarthropathy from January 1998 to December 2008. A total of11 patients (six males and five females) with a mean age of 56 year and diabetes of a mean duration of 15.4 years with ankle tibio-talar arthrodesis using retrograde nailing or external fixator for Charcot''s neuroarthropathy were enrolled for the analysis. Neuropathy was clinically diagnosed, documented and substantiated using the monofilament test. All procedures were performed in Eichenholz stage II/III.Six patients were treated with uniplanar external fixator, while the remaining five underwent retrograde intramedullary interlocking nail. The outcomes were measured for union radiologically, development of complications and clinical follow-up, according to digital archiving systems and old case notes.

Results:

All five (100%) patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7%) and a delayed union which went on to full osseous union.

Conclusion:

The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot''s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.     

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.     

Salvage of infected total knee arthroplasty with Ilizarov external fixator

Background:

Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA) with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA.

Materials and Methods:

16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator.

Results:

Union was achieved in 15 patients (93.75%). The mean duration for union (frame application time) in these patients was 28.33 weeks (range 22 to 36 weeks). Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034). Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls) was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035).

Conclusion:

Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.     

全环移动式外固定器的生物力学原理与临床应用

自１９８６年６月开始用自制的“全环移动式外固定器”此治疗新鲜骨折１４６例，陈旧性骨折１６例，骨不连４例，骨延长１３例，滕内翻畸形５例共１８４例，疗效满意，对本外固定器在各种不同的固定方式下进行生物力学测试，表明了不同的骨骼穿针数量，娄型，方向，部位与骨折固定稳定性的关系。