组合式外固定器治疗合并患肢短缩的足踝部畸形

背景：传统的足踝部畸形的矫正需要通过手术来完成，术后需要“静态”的维持。Ilizarov技术遵循的“张力-应力法则”和“牵拉组织再生技术”，在一定程度上打破了传统的矫形模式。目的：探讨Ilizarov技术治疗合并患肢短缩的足踝部畸形的临床疗效。方法：回顾分析2006年8月至2012年10月采用Ilizarov技术治疗的17例下肢及足踝部畸形患者的临床资料。其中男10例，女7例，年龄20~37岁，平均27.5岁。脊髓灰质炎后遗症导致患肢短缩合并足踝负重位外翻畸形患者5例，先天性马蹄内翻足合并患肢短缩7例，高弓足合并患肢短缩3例，跟腱挛缩、仰趾畸形合并患肢短缩2例。所有患者在有限手术重建足踝部软组织平衡或者截骨矫正畸形后安装Ilizarov组合式外固定支架，同时做胫骨的延长。结果：17例患者佩戴Ilizarov支架的时间是16~44周，足踝部矫形支架在3~6个月矫形满意、骨融合确实后单独拆除，骨延长支架根据需要继续佩戴。所有患者都获得随访，随访时间6~48个月，患肢延长2~6 cm，延长段骨矿化满意，足踝部矫形满意。足踝功能参照AOFAS评分：术前（43±5.1）分，术后（76±7.2）分。结论：对于各种原因导致的合并下肢短缩的足踝部畸形的矫治，Ilizarov技术灵活的器械组合可同时完成多方向的畸形矫正，在矫正畸形的同时实施骨延长术。

Treatment of foot and ankle deformity combined with shortening limb by combined external fixator

Background：The traditional correction of foot and ankle deformity usually can be achieved by surgery. Postoperative static state should be maintained. Followed by the Tension-Stress Rule and Distraction Histogenesis, Ilizarov technique breaks the traditional patterns of orthopaedic to some extent. Objective：To investigate clinical outcome of Ilizarov technique for treating foot and ankle deformity combined with shorten-ing limb. Methods： A retrospective analysis was made in 17 cases of lower extremity and foot and ankle deformity treated with Ilizarov technique between August 2006 and October 2012 in our hospital. There were 10 males and 7 females with a mean age of 27.5 years （range, 20-37 years）. There were 5 cases with ankle valgus deformity in weight loading caused by polio-myelitis, 7 cases with congenital talipes equinovarus, 3 cases with talipes cavus, and 2 cases with contracture of Achilles ten-don and deformity of pes calcaneus. Meanwhile, all patients suffered from shortening limb. After reconstruction of ankle soft tissue balance or osteotomy, Ilizarov external fixator was installed and tibial lengthen was made simultaneously. Results：Seventeen patients wore the Ilizarov scaffold for 16-44 weeks. Ankle＇s orthopedic scaffold was dismantled when satisfactory correction and bone fusion were achieved 3-6 months later. The patients continued to wear bone lengthening scaffold as required. The duration of follow-up in all patients ranged from 6 to 48 months. The length of affected limb in-creased 2-6 cm. The bone mineralization of prolongation and ankle correction was satisfied. AOFAS scores for foot and an-kle were 43±5.1 and 76±7.2 before and after operation, respectively. Conclusions：Ilizarov technique can be effectively used for deformity of lower limbs and ankle combined with shortening limb resulting from various causes.