目的 探讨微创截骨Ilizarov骨延长术治疗先天性跖骨短小症的效果.方法 2007-2014年,共治疗跖骨短小症48例,男性3例,女性45例;年龄16~36岁,平均22.7岁,其中37例为单侧跖骨短小,11例为双侧跖骨短小,2例同足第一、第四跖骨短小,跖骨短缩1.2~1.9 cm,平均1.4 cm,背侧入路,小切口,微创截骨器截骨,采用足背侧安装Orthofix M103短迷你轨道延长器,所有跖骨都延长到满意的长度,随访时间7~27个月,平均13个月.延长骨痂完全钙化.结果 延长长度12~19 mm,平均14 mm,骨延长指数(延长1 cm需要的时间)为15~20 d/cm,平均17 d/cm,按照美国足踝矫形外科协会(AOFAS)的功能评判标准,平均AOFAS评分为91.2分,优41例,良5例,可2例.每个足趾延长后足背遗留直径1 mm点状瘢痕6个,足背切口为线性瘢痕,长7 mm,对功能无任何影响,全部患者对延长的结果和足外观满意.结论 探讨微创截骨Ilizarov骨延长术治疗先天性跖骨短小症,微创截骨,手术创伤小,患者的痛苦小,延长过程中,新生骨生长良好,减少了骨不连的发生,使短小的跖骨恢复到满意的长度,足趾功能恢复好,是一种值得推荐的好方法.

Objective To report treatment of post-traumatic Achilles tendon contracture with Ilizarov technique and tendon lengthening.Methods From March 2011 to December 2014,27 cases of post-traumatic Achilles tendon contracture were treated at our department.They were 16 males and 11 females,13 to 52 years of age (average,31.2 years).The left side was affected in 13 cases and the right side in 14.Eighteen cases had simple Achilles tendon contracture while the other 9 were complicated with other foot deformities.The causes were soft tissue injury and fracture at the leg in 19 cases,Volkmann's contracture in 5,and unknown in 3.Based on the X-ray tibio-sole angle of the affected foot,the treatment protocols included Ilizarov distraction,lengthening of the Achilles tendon,tibialis posterior,flexor hallucis longus and flexor digitorum longus,and partial fusion of the foot joint.The deformity correction with the Ilizarov device started from the postoperative 7 days with a rate of 1 mm/day and continued until the ankle reached a dorsal flexion of 80°.This period lasted from 15 to 32 days (average,23 days).The fixation was maintained for 6 weeks after the fixation angle was stabilized.After the external fixators were removed,the ankle was fixated with plaster or splints for 3 months.Results The follow-ups ranged from 6 to 36 months (average,20 months).At the last follow up,25 cases (92.6％) achieved a tibio-sole angle of 90° and natural walking postures.Two patients (7.4％) who had the tibo-sole angle rebounded to 105° needed a pad at the posterior sole to recover natural walking.Nine patients had foot digital flexion deformities which were not treated further.Conclusion For post-traumatic Achilles tendon contracture,Ilizarov technique combined with tendon lengthening is fairly effective and safe,leading to a low rate of recurrence.

Objective To evaluate the residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomy to treat massive infectious defect of the tibia.Methods From January 2005 to January 2012,we treated 35 patients with massive infectious tibial defect.They were 26 men and 9 women,aged from 25 to 71 years (average,43 years).Sequestra exposure was found in 15 cases and pus discharge in 12.After excision of the infectious segments,the tibia was shortened by 11.2 cm on average (range,from 8 to 21 cm).After full thickness sequestra excision,thorough debridement and irrigation,the defects of bone and soft tissue were treated by two-segmental osteotomy,residual bone lengthening and compression fixation using oblique pins.External fixation was removed after bone union.The Paley scoring system for healing of bone infection was used to evaluate the treatment outcomes.Results The 35 patients were followed up for an average of 33 months (range,from 21 to 70 months).The rate of bone lengthening was 0.67 mm/d respectively for the 2 bone segments and 1.34 mm/d for the entire tibia.The wounds healed after an average time of 25 days (range,from 15 to 68 days).Bone lengthening lasted from 2.5 to 5.6 months (average,2.8 months).Compared with one-segmental lengthening,two-segmental lengthening was faster by 3 to 6 months (average,4.7 months).Osseous healing was achieved after 25 months on average (range,from 15 to 37 months).All the patients obtained fracture union with no recurrent infection,fine alignment of the affected lower limb,and isometry between the 2 lower limbs.All cases were excellent by the Paley scoring system.Conclusion To treat massive infectious defect of the tibia,the residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomv can reduce patients' pain and shorten treatment cycle,leading to complete cure of infectious bone defects.

目的：探讨带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗股骨短缩畸形的效果。方法回顾性分析61例股骨短缩畸形患者的临床资料，其中采用带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗36例（观察组），采用单纯Ilizarov外固定器行股骨延长术治疗25例（对照组）。比较手术后两组患者的骨延长相关参数（速度、长度）、外固定佩戴时间、术后半年膝关节活动度及并发症情况。结果所有患者均获1.5～4.5（2.5±2.0）年的随访。两组骨延长长度和延长速度的比较差异无统计学意义（ P＞0.05）；观察组外固定佩戴时间显著短于对照组（P＜0.05），膝关节活动度明显高于对照组（P＜0.05）；观察组无再骨折、畸形、针道感染等并发症发生，对照组出现严重针道感染7例9针，观察组并发症发生率明显低于对照组（ P＜0.05）。结论带锁髓内钉结合Ilizarov外固定器行股骨延长术治疗股骨短缩畸形，能减少股骨穿针，缩短外固定器佩戴时间，增加舒适度，有利于患者尽早行关节功能锻炼，且能减少关节僵硬并发症的发生。

Objective To investigate the clinical effect of ilizarov technique combined minimally invasive high tibial osteotomy therapy for the treatment of knee osteoarthritis with varus.Methods From February 2000 to December 2013,Ilizarov technique combined minimally invasive high tibial osteotomy was performed in 138 patients (148 knees) with clinical diagnosis of knee osteoarthritis with varus.The femorotibial angles and the medial tibial joint clearance were measured on the standing X-ray of knee joint pre and post-operation in order to compare their changes.Simultaneously,American Hospital for Special Surgery score(HSS score) was conducted and compared.Results All the patients were followed up for (66.5 ± 6.6) months.The femorotibial angle (FTA),medial tibial joint clearance,and HSS score in the post-operation were all significantly better than the score in the pre-procedure (P ＜ 0.05).Clinical result showed that all the patients had relief of knee pain and symptoms with the excellent rate of 91.2％.Conclusions Ilizarov technique combined minimally invasive high tibial osteotomy therapy is an effective procedure for treatment of knee osteoarthritis with varus.