CAJ | 학술논문

目的探讨Ilizarov技术同期治疗胫骨缺损合并马蹄足畸形的疗效. 方法回顾性分析2005年1月至2012年1月应用Ilizarov技术同期治疗的17例由于创伤、感染或医源性因素所致的胫骨骨缺损合并马蹄足畸形患者资料,男12例,女5例；年龄12～47岁,平均29.0岁；左侧11例,右侧6例.骨缺损长度为1.5 ～ 14.0 cm,平均7.3 cm.合并马蹄足畸形20°～ 50°,平均37°.4例患者合并骨髓炎.术后1周开始骨段搬运,速度为1 mm/d,分4～6次完成；同时调整足踝部外固定支架矫正足部畸形,速度为2～3 mm/d,分3～4次完成. 结果 17例患者术后获12～70个月(平均33.0个月)随访.外固定支架带架时间为7～27个月(平均14.0个月).所有患者术后无感染复发,患侧下肢力线正常,双侧肢体长度差异＜2 cm.末次随访时,根据Paley等骨不连治疗的骨性结果评价标准评定疗效:优9例,良8例；17例患者马蹄足畸形同期矫正；美国足踝外科协会踝与后足评分为85 ～96分,平均92.0分.3例患者遗留轻度足下垂畸形,其踝关节活动度＜15°. 结论 Ilizarov技术可同期治疗胫骨骨缺损合并马蹄足畸形,方便患者早期足负重行走锻炼,缩短了治疗周期,临床疗效满意.
목적 탐토Ilizarov기술동기치료경골결손합병마제족기형적료효. 방법 회고성분석2005년1월지2012년1월응용Ilizarov기술동기치료적17례유우창상、감염혹의원성인소소치적경골골결손합병마제족기형환자자료,남12례,녀5례；년령12～47세,평균29.0세；좌측11례,우측6례.골결손장도위1.5 ～ 14.0 cm,평균7.3 cm.합병마제족기형20°～ 50°,평균37°.4례환자합병골수염.술후1주개시골단반운,속도위1 mm/d,분4～6차완성；동시조정족과부외고정지가교정족부기형,속도위2～3 mm/d,분3～4차완성. 결과 17례환자술후획12～70개월(평균33.0개월)수방.외고정지가대가시간위7～27개월(평균14.0개월).소유환자술후무감염복발,환측하지력선정상,쌍측지체장도차이＜2 cm.말차수방시,근거Paley등골불련치료적골성결과평개표준평정료효:우9례,량8례；17례환자마제족기형동기교정；미국족과외과협회과여후족평분위85 ～96분,평균92.0분.3례환자유류경도족하수기형,기과관절활동도＜15°. 결론 Ilizarov기술가동기치료경골골결손합병마제족기형,방편환자조기족부중행주단련,축단료치료주기,림상료효만의.
Objective To report one-stage treatment of tibial defect and equinus deformity using Ilizarov technique.Methods From January 2005 to January 2012,we used Ilizarov technique to treat 17 cases of traumatic,infected or iatrogenic tibial defect and equines deformity at one stage.They were 12 men and 5 women,aged from 12 to 47 years (average,29.0 years).All cases were unilateral,with a bone defect of 1.5 cm to 14.0 cm (average,7.3 cm).The complicated foot drop deformity ranged from 20° to 50° (average,37°).Osteomyelitis was complicated in 4 cases.Bone transport was started one week after operation with a speed of 1 mm/d and completed in 4 to 6 times.Simultaneously,the adjustment of external fixator was performed to correct the foot equines deformity with a speed of 2 to 3 mm/d and completed in 3 to 4 times.Results The 17 cases were followed up for a mean duration of 33.0 months (from 12 to 70 months).The external fixation time ranged from 7 to 27 months (mean,14.0 months).No postoperative infection was observed.The lower limb mechanical shaft was restored to normal in all cases.The limb disparity was ＜ 2 cm.At the last follow-up,by Paley's criteria for nonunion treatment,the therapeutic outcomes were rated as excellent in 9 cases and good in 8.The equines deformity was corrected at the primary stage in all cases.The American Orthopaedic Foot & Ankle Society(AOFAS) scores ranged from 85 to 96 points (average,92.0 points).Slight foot drop was observed in 3 cases,with an ankle range of motion of ＜ 15°.Conclusions Ilizarov technique can be used to treat at one stage patients with tibial defect and equines deformity.It can allow for early weight-bearing exercise,shorten the treatment cycle and lead to satisfactory outcomes for the patients.