软骨发育不全属于骨发育不良疾病范畴,患者由于长骨的软骨内骨化受限,导致身材矮小、躯干与四肢的比例失调,称为肢根型侏儒症,是最常见的侏儒症类型.由于四肢显著短小,患者的日常生活受到严重影响,无法进行正常的社交活动和工作,改善生活质量的需求十分迫切.Ilizarov技术在严格控制下对肢体进行有限延长,可改善患者生活质量.文献报道Ilizarov技术在国外已广泛开展,但在我国尚未普及,主要原因在于适应证、手术技术及术后管理不规范.本文对国内外相关文献进行综述,以进一步了解Ilizarov技术治疗软骨发育不全下肢畸形的发展现状,为其临床推广提供理论支持.

Objective:Based on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making.Methods:A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method, postoperative fixation method, and other information were collected.Results:Among the 22 062 patients, there were 13 046 males (59.13%) and 9 016 females (40.87%); the age at operation ranged from 1 to 77 years, with a median of 17 years, and 20 026 cases (90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds (of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord, congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus, equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release, tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including 11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases (12.28%), combined external fixator in 3 966 cases (17.98%), and plaster or brace fixation in 15 387 cases (69.74%).Conclusion:Male patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.

Objective:To investigate the surgical method and preliminary effectiveness of Ilizarov technique in the treatment of lower limb deformity caused by achondroplasia.Methods:The clinical data of 38 patients with lower limb deformity caused by achondroplasia treated by Ilizarov technique between February 2014 and September 2021 were retrospectively analyzed. There were 18 males and 20 females, the age ranged from 7 to 34 years, with an average of 14.8 years. All patients presented with bilateral knee varus deformity. The preoperative varus angles was (15.2±4.2)°, and knee society score (KSS) was 61.8±7.2. Nine of these patients underwent tibia and fibula osteotomy, 29 cases underwent tibia and fibula osteotomy and bone lengthening at the same time. Full-length bearing position X-ray films of bilateral lower limbs were taken to measure the bilateral varus angles, analyze the healing index, and record the occurrence of complications. KSS score was used to evaluate the improvement of knee joint function before and after operation.Results:All 38 cases were followed up 9-65 months, with an average of 26.3 months. Needle tract infection occurred in 4 cases and needle tract loosening occurred in 2 cases after operation, which were improved after symptomatic treatment such as dressing change, Kirschner wire change, and oral antibiotics, and no neurovascular injury occurred in all patients. The external fixator was worn for 3-11 months after operation, with an average of 7.6 months, and the healing index was 43-59 d/cm, with an average of 50.3 d/cm. At last follow-up, the leg was 3-10 cm longer, with an average of 5.5 cm. The varus angles was (1.5±0.2)° and the KSS score was 93.7±2.6, which significantly improved when compared with those before operation ( P<0.05).Conclusion:Ilizarov technique is a safe and effective method for the treatment of short limb with genu varus deformity caused by achondroplasia, which can improve the quality of life of patients.

Objective:To summarize and analyze the characteristics and treatment strategies of post-traumatic lower limb deformity based on QIN Sihe Orthopaedic Surgery Database.Methods:A clinical data of 837 patients with post-traumatic lower limb deformities treated by orthopaedic surgery between May 25, 1978 and December 31, 2020 in QIN Sihe Orthopaedic Surgery Database were analyzed retrospectively. The information of the patient's gender, age at the time of surgery, region of origin, cause of trauma, deformity side, orthopedic surgery related information (operation time, location, type, and fixation method after operation) were summarized and analyzed.Results:All patients came from 32 provinces, municipalities, autonomous regions, and Taiwan in China. Among them, 551 cases (65.83%) were male and 286 cases (34.17%) were female. The age of the patients at the time of surgery was 3-84 years old, with an average of 27.6 years old, and the most patients were 16-45 years old (559 cases, 66.78%). The main cause of trauma was traffic accident injury (639 cases, 76.34%). The deformity mainly involved unilateral limbs, including 394 cases (47.07%) on the left side and 376 cases (44.92%) on the right side. The most patients were admitted between 2008 and 2017, accounting for 53.05% (444/837). All patients were operated on one or more sites (1 048 sites), among which ankle and toe surgery were the most, accounting for 48.38% (507/1 048). The patients received 1204 surgeries including tendon lengthening and soft tissue contracture release, et al. Orthopedic surgery combined with bone external fixation was used in 624 cases (467 cases of Ilizarov external fixation and 157 cases of combined external fixation), and plaster or brace external fixation was used in 213 cases.Conclusion:Post-traumatic lower extremity deformity patients have a large proportion of males, with a wide geographical distribution, involving various parts of the lower extremities, and most commonly in the foot and ankle. Orthopedic surgery combined with bone external fixation (Ilizarov technique) is the main methods for correction and functional reconstruction of post-traumatic lower limb deformity.

[目的]探讨Ilizarov技术同期治疗胫骨感染性骨缺损伴垂足畸形的临床疗效.[方法]2013年1月-2020年9月对45例胫骨感染性骨缺损伴垂足畸形行病灶清理、病变骨段切除、Ilizarov外固定器骨搬移、足部牵拉矫形,总结临床与影像结果.[结果]所有患者顺利完成手术,无重要血管、神经损伤.创面愈合时间(36.22±11.24)d,外架调整时间(3.26±1.32)个月,骨搬移长度(6.74±3.26)cm,骨缺损愈合时间(20.22±5.84)个月.随访时间(28.6±12.4)个月,随时间推移,VAS评分显著下降(P＜0.05),AOFAS评分和踝关节ROM显著增加(P＜0.05).影像方面,随时间推移,胫骨干成角畸形显著矫正(P＜0.05),mMPT和mLDTA均无显著改变(P＞0.05),双侧胫骨长度差显著减小(P＜0.05),所有患者骨缺损及截骨处均骨性愈合.[结论]采用Ilizarov技术同期治疗骨髓炎、修复骨大段缺损和矫正垂足畸形临床效果良好.

目的 回顾性分析35年中应用肢体延长术治疗的下肢短缩畸形及不等长患者数据,探讨肢体延长术应用对象的分布及变化情况.方法 通过对矫形外科病例数据库进行资料提取,选取1983年1月至2017年12月接受下肢延长术治疗的2574例患者资料.其中男1556例(60.45％),女1018例(39.55％);年龄3～58岁,平均(21.91±10.18)岁.统计分析患者性别、年龄、术前步态、延长部位、侧别及原发疾病种类等情况.结果 接受手术患者主要集中在11～30岁(2204例,85.63％);术前行走状态包括轻度跛行l 402例(54.47％),重度跛行528例(20.51％)等9种情况;手术延长部位包括髂骨、胫腓骨、股骨、跟骨、跖骨、跗骨等6个部位,接受髂骨延长术明显出现随时间变化的趋势;原发疾病种类包括以脊髓灰质炎后遗症为主的超过54种疾病.结论 患者数据分布规律反应出,接受肢体延长术治疗的患者群体中,医疗资源存在向男性倾斜的倾向,不同年龄段患者对治疗需求存在差异,患者改善功能的需求远超单纯改善外观需求,施术部位具有随时间出现变化的趋势,为了解下肢短缩畸形患者及肢体延长术的基本情况提供了经验与依据.

Objective:To investigate the clinical efficacy and indications of arthrolysis plus Ilizarov technique in the treatment of traumatic fibrous stiffness of the knee.Methods:The clinical data were analyzed retrospectively of the 9 patients (10 knees) with traumatic fibrous stiffness who had been treated by arthrolysis plus Ilizarov technique from January 2012 to December 2020 at Department of Orthopaedics, Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids. There were 8 males and one female, aged from 15 to 42 years (average, 30.2 years). The left side was affected in 2 cases, the right side in 6 ones and bilateral sides in one. Their knee stiffness was all caused by injury around the knee. The time from injury to treatment ranged from 12 months to 38 years (average, 16.5 years). The admission examination revealed that the knee extension ranged from -40° to 0° and the knee flexion from -10° to 40°. Wearing time for the external fixator and incidence of complications were recorded; the ranges of knee motion were compared before and after treatment; the Qin Sihe criteria for postoperative limb deformity correction were used at the last follow-up to evaluate the curative efficacy.Results:The 9 patients were followed up for 20 to 78 months with an average of 35 months. The external fixators were worn for 14 to 200 days with an average of 78.4 days. During the traction period, pin tract reaction (3 holes) occurred in 2 patients with 3 knees, pin tract infection (2 holes) in 2 patients with 2 knees, the incision healed poorly in one patient, and no other complications occurred. The functional recovery of the knee was good at the last follow-up. The knee extension was 0°, insignificantly different from the preoperative value (-6.5°±12.9°) ( t=-1.591, P=0.146); the flexion angle was 70.0°±17.6°, significantly better than the preoperative value (15.0°±17.2°) ( t=-6.822, P< 0.001). According to the Qin Sihe postoperative criteria, the curative efficacy at the last follow-up was excellent in 7 knees and good in 3. Conclusion:In the treatment of traumatic fibrous stiffness of the knee, when the efficacy of simple arthrolysis is not good enough, a combination with Ilizarov technique can help improve the postoperative knee function and prevent severe complications.

背景:幼年期的股骨远端骨骺损伤,随年龄增长常出现不同程度的股骨短缩、膝关节内外翻和前弓等畸形,传统方法需多次手术治疗.目的:探讨应用Ilizarov技术治疗股骨短缩并膝关节畸形的手术方法和临床疗效.方法:回顾性分析2013年1月至2018年4月应用Ilizarov技术治疗的9例股骨远端骨骺损伤后遗股骨短缩并膝关节畸形患者的临床资料,男6例,女3例;年龄18～26岁,平均(22.1±2.9)岁;左侧2例,右侧7例;合并膝内、外翻5例,股骨髁上前弓4例.术中即时矫正膝关节内外翻及前弓畸形,然后在股骨中段斜形截骨,安装Ilizarov外固定器,术后逐渐调整外固定器,进行股骨延长及远端残留畸形的微调.随访复查双下肢全长正侧位X线片,观察下肢肢体长度、下肢力线、关节线及延长成骨情况,膝关节功能评分表(KSS)评价术后膝关节功能.结果:9例全部获得随访,随访时间为12～40个月,平均(20.5±7.6)个月.患者术后股骨短缩畸形和膝关节畸形均获得矫正.术后股骨延长3.0～7.5 cm,平均(4.1±0.9)cm;矫正膝关节内外翻畸形15°～25°,平均17.9°±2.8°;前弓畸形12°～20°,平均14.4°±2.4°.术后外固定器佩戴时间6～14个月,平均(9.3±2.6)个月.术后3例发生针道感染,换药处理后感染控制;1例针道松动,更换穿针位置,重新固定,均未出现神经血管损伤.末次随访膝关节KSS评分79～100分,平均(94.2±3.9)分.结论:Ilizarov技术治疗股骨远端骺损伤后遗股骨短缩合并膝关节畸形,能够准确恢复下肢长度和力线,手术创伤小、手术次数少、并发症少.

[目的]利用三维步态分析探讨胫骨近端截骨Ilizarov外固定技术治疗内侧间室膝骨关节炎患者手术前后时空、运动学及动力学变化.[方法]对2016年9月～2018年12月本科采用胫骨近端低位微创截骨Ilizarov外固定技术治疗的11例内侧间室膝骨关节炎患者(21膝)进行步态分析研究,记录比较术前、术后拆除外固定架时及术后6个月3个时间点步态周期时空参数、运 动学及运动力学参数.[结果]11例患者步幅和步速在术前、拆除外固定器时及术后6个月比较差异无统计学意义(P＞0.05).步态运动学检测方面,随时间推移,21膝的屈膝角度、伸膝角度均显著增加(P＜0.05);内翻角度、外翻角度均显著减少(P＜0.05).踝关节活动范围显著增加(P＜0.05),踝关节外翻角度显著增加(P＜0.05).运动力学测试方面,随时间推移,膝关节内收力矩、内收角冲量均显著减少(P＜0.05);拆除外固定器时踝关节外翻力矩较术前增加(P＜0.05),术后6个月随访时与拆除外固定器时踝关节外翻力矩比较差异无统计学意义(P＞0.05);拆除外固定器时足底中心压力轨迹较术前明显向外侧偏移(P＜0.05),术后6个月时与拆除外固定器时比较差异无统计学意义(P＜0.05).[结论]胫骨近端微创截骨Ilizarov外固定技术治疗内侧间室膝骨关节炎符合生物力学要求,步态分析测试可对该技术的临床疗效进行准确评估.

背景:胫骨缺损常合并软组织损伤、肢体畸形、不等长等问题.目前的临床分型并不能涵盖一些复杂胫骨缺损情况.目的:从Ilizarov骨搬移技术角度探讨成人非感染性胫骨缺损临床新分型及治疗策略.方法:分析2000年4月至2017年1月应用Ilizarov骨搬移技术治疗的58例成人无感染性胫骨缺损.依据胫骨缺损的长度、部位、是否合并畸形以及相应的Ilizarov骨搬移手段分为5个类型.Ⅰ型:1 cm＜中下/上段骨缺损≤6 cm,无明显成角畸形.采用胫骨单节段截骨,向缺损端搬移.Ⅱ型:6 cm＜中下/上段骨缺损≤10 cm,无明显成角畸形.采用双节段截骨同步向缺损端骨搬移.Ⅲ型:6cm＜中段骨缺损≤10 cm,无明显成角畸形,胫骨上、下双节段截骨,向心性骨搬移.Ⅳ型:6 cm＜上、下两段缺损≤10 cm,中段残留活骨≥6 cm,无明显成角畸形.将胫骨中间残留的一段活骨2处截骨,成为3块骨,中间骨块固定作为两块骨搬移再生的“母骨”支点,上下两段骨块反向分离牵拉,一期修复上下2区骨缺损.Ⅴ型:胫骨缺损＞10 cm,合并骨干＞7°成角畸形.采用腓骨上下两处截骨,先纵向牵拉使胫骨缺损间隙加大、成角畸形矫正,再横向牵拉将腓骨中间段搬移至胫骨缺损处,使其腓骨胫骨化.观察5个临床分型组骨缺损修复骨愈合、畸形矫正、有无肢体短缩等并发症、汇合端愈合情况等.拆除外固定后随访,采用改良Paley骨不连评价标准进行评价.结果:55例患者获得随访,随访时间24～104个月,平均(32.0±21.4)个月.所有患者均实现骨缺损修复并最终骨性愈合,骨愈合指数35～60d/cm,平均(49.0±6.4) d/cm.1例Ⅳ型,4例Ⅴ型患者术后肢体短缩＞2.5 cm(2.7～3.5 cm).末次随访无＞7°局部畸形病例.未发生1例深部感染、血管神经损伤等并发症.17例因汇合端骨愈合迟缓,二次手术取自体髂骨植骨.带外固定架时间5～28个月.治疗效果:优41例、良11例、可3例,优良率94.5％(52/55).结论:成人胫骨缺损新分型既有利于病情评估亦利于制定合理的治疗方案.针对不同类型制定的个体化骨搬移重建方法,可一期手术修复骨缺损、矫正畸形、延长肢体,临床疗效显著,值得推广.

Background: Severe flexion contracture deformity of the knee joint is often found in patients with rheumatoid arthritis (RA), which severly limiting the walking ability. Total knee arthroplasty (TKA) is a good option, but it is difficult and complicated to perform TKA, especially for juvenile patients with severe flexion deformity. There are limited reports about management of severe knee flexion contracture (KFC) of RA with Ilizarov technique. Purpose: The aim of this study was to retrospectively analyzed the results of Ilizarov technique for the juvenile rheumatoid arthritis (JRA) patients with severe knee flexion contracture (KFC). Materials and methods: From March 2000 to October 2018, nine patients (15 knees) with severe knee flexion contracture (KFC) of JRA who underwent Ilizarov knee joint distraction technique were reviewed retrospectively. There were 4 male (6 knees), 5 female (9 knees) with an average age of 15 years old (12-19years old). However, 6 cases also had equinus deformity, whose foot and ankle joint distraction device were installed simultaneously. The mean preoperative KFC and ROM angle of the knee were 48.8 +/- 16.7 degrees (mean +/- standard deviation) and 41.6 +/- 15.3 degrees, respectively. Preoperative VAS score (Visual analogue score) and HSS score (hospital for special surgery knee score) were 7.7 +/- 2.5 and 37.4 +/- 11.2, respectively. Results: The average time of follow-up was 47.6 +/- 21.3 months. All the patients achieved full correction of flexion contracture at the end of distraction. At the last follow-up, the mean flexion degree and ROM were 12.1 +/- 11.7 degrees and 23.5 +/- 19.3 degrees respectively, which were significantly different compared with preoperative condition. The total duration of ring fixation application was 10-21 weeks, with an average time of 14.3 weeks. The mean VAS and HSS score at the last follow-up were 1.4 +/- 1.2 and 71.5 +/- 7.3, which were significantly improvement to the preoperative condition. There were no severe complications during treatment in this study. Pin tract infection occurred in 7 cases during the knee joint distraction and the infection were controlled after slowing down the distraction speed and wrapping with alcohol gauze at the interface between the fixing pin and the skin. Conclusion: Ilizarov method is an effective and safe procedure to treat severe KFC in JRA which can correct deformities, relieve pain and improve the function of weight bearing. Pin tract infection and knee joint stiffness and even fusion are common problems, but correction of deformity of the knee using Ilizarov technique has possible positive outcome for possible further surgery if necessary. Translational potential: Our study shows that Ilizarov knee joint distraction for treatment of severe KFC in JRA is effective and safe. It is concluded that this method offers a new option for juvenile rheumatoid arthritis.

[目的]介绍Ilizarov外固定治疗多发性骨软骨瘤致前臂畸形的手术技术.[方法]2014年7月～2017年7月收治6例多发性骨软骨瘤前臂畸形患者,男2例,女4例,年龄6～20岁,平均(12.72±5.23)岁;应用Ilizarov外固定器行尺骨牵伸延长、桡骨截骨矫形等处理,1例患者同期行尺骨远端骨软骨瘤切除术,1例患者同期行桡骨近端骨软骨瘤切除术.[结果]患者前臂畸形矫正满意;尺骨近端延长25～35 mm,平均(30.00±5.00) mm,均达到骨性愈合,未见延迟愈合;桡骨截骨矫形良好、截骨端骨性愈合;腕关节尺偏畸形得到大部分纠正,下尺桡关节复位,前臂旋转功能明显恢复,腕关节及肘关节活动功能明显改善.术后1例患者出现轻度屈腕畸形,予以配置辅具与前臂外固定器相结合很快纠正并有效预防复发.[结论] Ilizarov外固定技术治疗多发性骨软骨瘤致前臂畸形的临床效果满意,具有创伤小、并发症少、操作简便灵活等优点.

Objective:To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method.Methods:From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator.Results:Of the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function.Conclusion:Limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.

Objective:To analyze the data of external fixation instruments (including Ilizarov instruments) used by QIN Sihe orthopaedic surgical team in the treatment of limb deformities in the past 30 years, and to explore the indications for the application of modern external fixation techniques in the correction of limb deformities and individual device configuration selection strategy.Methods:According to QIN Sihe orthopaedic surgical team, the use of external fixator between January 1988 and December 2017 was analyzed retrospectively. The total use of external fixation and the proportion of different external fixators were analyzed in gender, different operation time, different age, different parts, and different diseases.Results:External fixators were used in 8 113 patients, 69 of them were used simultaneously in both lower extremity surgery, so 8 182 external fixators were used. Among them, there were 4 725 (57.74%) combined external fixators, 3 388 (41.41%) Ilizarov circle fixators, 64 (0.78%) single arm external fixators (including Orthofix), 5 (0.06%) Taylor space external fixators. There were 4 487 males (55.31%) and 3 626 females (44.69%). According to the analysis of different time periods, the number of external fixators increased year by year, and the number of applications increased after 2000. The main age of the patients was 11-30 years old, of which 1 819 sets (22.23%) were used at the age of 21-25 years. The use of the external fixator covered almost all parts of the limbs, with the ankle and toe areas being the most common, reaching 4 664 sets (57.00%), and the upper extremities the least, with 152 sets (1.86%). The 8 113 cases covered more than a dozen disciplines and more than 150 kinds of diseases. The top 5 diseases were poliomyelitis sequelae, cerebral palsy, deformity of lower extremity after spina bifida, traumatic sequelae, and congenital equinovarus foot.Conclusion:Ilizarov technique has been widely used in extremity deformity, disability, and complicated orthopedic diseases caused by vascular, lymphoid, nerve, skin, endocrine, and other diseases. The indication of operation is far beyond the scope of orthopedics. The domestic external fixator and its mounting tools can basically meet the requirements of various treatments. The technique of external fixation has entered a new era of tension tissue regeneration under stress control, natural repair of tissue trauma and deformity, and reconstruction of limb function.

目的 探讨Ilizarov技术矫治儿童踝关节骨折后遗内翻畸形的疗效.方法 回顾性分析2010年5月至2017年7月在国家康复辅具研究中心附属康复医院治疗的10例踝内翻畸形患者的病历资料,均为14岁以前踝关节外伤后逐渐形成.男6例,女4例,平均年龄17.4岁(10～26岁),左侧2例,右侧8例,6例存在内踝皮肤瘢痕挛缩,4例同时伴患肢短缩.应用CORA方法确定踝内翻畸形成角中心,定制Ilizarov足踝环式外固定架,手术采用微创截骨器行踝上截骨,2例增加跟骨截骨,安装环式外固定架,术后通过调整外固定架逐步矫正踝内翻及合并畸形,2例同时进行肢体延长.采用AOFAS评分标准评估治疗前后功能改善情况.结果 10例患者均获随访,随访时间12～96个月(平均36个月),所有患者伤口愈合顺利,术后3～5天患肢可开始锻炼站立走路,患者及家属对矫形后外观及功能改善表示满意,带架时间平均16周(12～24周),2例矫形同时延长的儿童患者出现一定程度踝内翻复发;AOFAS评分:术前平均40分(30～65分),术后平均85分(75～95分).结论 Ilizarov技术矫治儿童踝关节骨折后遗内翻畸形具有微创、软组织并发症少灵活可调、可同时矫正合并畸形、可早期负重、有利骨愈合和软组织重建、力线恢复满意等优势,安全有效,值得推广.

目的 统计分析秦泗河矫形外科团队30年间治疗四肢畸形所应用的骨外固定器械(包括Ilizarov器械)数据,探讨现代骨外固定技术矫正四肢畸形的应用指征、个体化器械构型选择策略等.方法 依据秦泗河矫形外科团队肢体畸形矫形手术病例数据库,回顾性统计分析1988年1月-2017年12月外固定器使用情况,分别从外固定器总体使用情况,不同性别、不同手术时间段、不同年龄段、不同部位及不同病种外固定器应用情况等方面,进行外固定器总体使用情况及不同外固定器构成进行统计、分析.结果 8 113例患者手术中应用了骨外固定器,其中双下肢手术同时应用者69例,共应用8 182套外固定器.其中组合式外固定器4 725套(57.74％)、Ilizarov环式外固定器3 388套(41.41％)、单臂外固定器64套(其中包括Orthofix器械)(0.78％)、Taylor空间外固定器5套(0.06％).男4 487例(55.31％),女3 626例(44.69％).从不同时间段分析显示,外固定器使用数量逐年增加,2000年后应用数量突破性增多.患者年龄以11～ 30岁为主,其中21～ 25岁使用最多,达1 819套(22.23％).外固定器应用部位几乎涵盖了四肢所有区域,其中踝足趾部位最多,达4 664套(57.00％);上肢最少,共152套(1.86％).8 113例中治疗的疾病涵盖了十余个学科、超过150个病种,其中使用外固定器治疗最多的前5位疾病为:脊髓灰质炎后遗症、脑性瘫痪、脊柱裂后遗下肢畸形、创伤后遗症、先天性马蹄内翻足.结论 Ilizarov技术已广泛应用于血管、淋巴、神经、皮肤、内分泌等疾病导致的肢体畸形、残疾以及骨科疑难杂症,其手术适应证远超出了骨科学范围.国产外固定器及其安装工具基本能满足各种治疗的要求.骨外固定技术已全面进入了应力控制下的牵拉组织再生,自然修复组织创伤与残缺、重建肢体功能的新时代.