CAJ | 학술논문

目的探讨Ilizarov技术治疗四肢畸形并发症的发生原因及防治经验.方法回顾性分析2000年1月至2010年10月采用Ilizarov技术治疗并获随访的846例各种四肢畸形患者的病例,男508例,女338例；年龄1.2～72岁,平均25.7岁；上肢畸形16例,下肢畸形830例.对治疗过程中(术中、术后)出现的并发症的种类、严重程度、处理方法和结果进行统计学分析.结果随访时间6～30个月,平均18个月.846例患者中,190例出现并发症,其中针道感染81例,关节活动障碍36例,皮肤热损伤6例,神经、血管损伤7例,骨延迟愈合8例,小腿骨筋膜间室综合征2例,关节脱位7例,断针5例,继发关节畸形8例,严重骨质疏松5例,皮疹6例,外固定器近端股骨干骨折4例,外固定器拆除后再骨折3例,畸形复发11例,其他1例.采用抗感染、功能训练、理疗、再次手术等方法进行对症处理,最终仍有13例遗留永久性功能障碍.结论应用Ilizarov技术在术前准备、手术操作、术后处理的各个环节均可出现多种问题与并发症.减少并发症发生的主要措施是,临床医生在应用Ilizarov技术前需要进行严格、系统培训,掌握手术适应证,理解Ilizarov技术原理,术前组装好个体化外固定器,严格遵循标准化手术操作与术后处理程序.
목적 탐토Ilizarov기술치료사지기형병발증적발생원인급방치경험.방법 회고성분석2000년1월지2010년10월채용Ilizarov기술치료병획수방적846례각충사지기형환자적병례,남508례,녀338례；년령1.2～72세,평균25.7세；상지기형16례,하지기형830례.대치료과정중(술중、술후)출현적병발증적충류、엄중정도、처리방법화결과진행통계학분석.결과 수방시간6～30개월,평균18개월.846례환자중,190례출현병발증,기중침도감염81례,관절활동장애36례,피부열손상6례,신경、혈관손상7례,골연지유합8례,소퇴골근막간실종합정2례,관절탈위7례,단침5례,계발관절기형8례,엄중골질소송5례,피진6례,외고정기근단고골간골절4례,외고정기탁제후재골절3례,기형복발11례,기타1례.채용항감염、공능훈련、리료、재차수술등방법진행대증처리,최종잉유13례유류영구성공능장애.결론 응용Ilizarov기술재술전준비、수술조작、술후처리적각개배절균가출현다충문제여병발증.감소병발증발생적주요조시시,림상의생재응용Ilizarov기술전수요진행엄격、계통배훈,장악수술괄응증,리해Ilizarov기술원리,술전조장호개체화외고정기,엄격준순표준화수술조작여술후처리정서.
Objective To analyze the causes of the complications in the treatment of limb deformities with the Ilizarov technique and to discuss the management and prevention of these complications.Methods From January 2000 to October 2010,846 patients with limb deformities (16 upper limbs and 830 lower limbs) who had been treated with Ilizarov technique were retrospectively analyzed,including 508 males and 338 females with an average age of 25.7 years (range,1.2-72).Statistical analysis was used to compare the type,severity,treatment methods and results of complications.Results Postoperative follow-up lasted for 6 to 30 months,with an average of 18 months.There were 81 cases of pin tract infections,36 cases of restricted joint movements,6 cases of skin thermal damage,7 cases of nerves and vessels injury,8 cases of bone delayed union,2 cases of osteofascial compartment syndrome,7 cases of dislocation,5 cases of fixed needle breakage,8 cases of secondary joint deformities,5 cases of serious osteoporosis,6 cases of skin eruption,4 cases of femoral fractures near to proximal external fixator,3 cases of subsequent fracture after external fixator dismantled,11 cases of deformity recurrence and 1 case of the others.Combining with anti-infection,functional training,physiotherapy,and the second operation therapy and so on,a permanent disability was finally left in 13 patients.Conclusion If the Ilizarov technique was used improperly,there would be multiple complications during the preoperative preparation,surgical procedures and postoperative management.Effective preventive measures should be taken,such as following the principle of the Ilizarov technique,standardizing operation procedures,strictly postoperative observation,correcting postoperative rehabilitation exercise guidance,regular follow-up radiography and postoperative adaptability dynamic adjustment of the external technique.