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。

Correction of posttraumatic varus and valgus knee deformities using the Taylor Spatial Frame

Objective To evaluate the clinical outcomes and correction accuracy of posttraumatic varus and valgus knee deformities using the Taylor Spatial Frame(TSF). Methods From June 2006 to December 2010, 26 patients with posttraumatic varus and valgus knee deformities who had been treated with the TSF combined with less invasive high tibial osteotomy (HTO) or supracondylar femur osteotomy (SFO) were retrospectively analyzed, including 19 males and 7 females with an average age of 39 years. There were 20 cases of posttraumatic varus knees and 6 valgus knees. Twenty one patients were treated with HTO and 3 with SFO, 2 with HTO and SFO simultaneously. During the operation, the TSF was firstly assembled and then the parameters of the frame were measured followed by less invasive percutaneous osteotomy. Correction was started seven to ten days after the operation following the time schedule provided by the computer program. Correction of the struts were performed 3 times per day, with a total movement of 0-3 mm. Results Through 7-35 days frame adjustments, 20 cases of deformities were fully corrected. X-ray showed that the mechanical axis deviations of the tibia and femur all were recovered to normal range, and the deformity of rotation, angulation and crispation were fully corrected. Six cases had residual slight angulation or crispation deformity(﹤4° or ﹤10 mm). Through the second 4-10 days frame adjustments, these 6 cases of deformities were fully corrected finally. New bone formation and consolidation on the osteotomy site were good. The fixators were removed from 2.5-6.0 months after surgery and the appearance of the limbs and the patients' gait recovered to normal and the keen pain disappeared. All patients were followed up for 12-60 months and without the recurrence of the deformity. Eleven cases occured pin site infection and were controlled by use of the sensitive antibiotics. One case occured refracture of the distal femur osteotomy site 1.5 months after frame removal. Through conservative treatment, the fracture finally healed. Conclusion Posttraumatic varus and valgus knee deformities can be effectively corrected by using TSF and with a high accuracy.