先天性胫骨缺如伴重度膝关节屈曲畸形的牵伸治疗1例.doc

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1、先天性胫骨缺如伴重度膝关节屈曲畸形的牵伸治疗1例作者：秦泗河李承鑫吴鸿飞周育松【关键词】屈膝畸形摘要：［目的］观察用膝关节牵伸技术治疗先天性胫骨缺如伴重度屈膝畸形的效果。［方法］1例先天性右胫骨完全缺如，股骨下端呈叉状，腓骨头与股骨下端形成不稳定的膝关节，伴屈膝畸形95°，于1岁半实施股骨下端修整术，5岁和8岁时分两期安装Ilizarov膝关节牵伸器，牵拉矫正屈膝畸形迗到伸膝0°位，使腓骨头与股骨下端成膝关节，拆牵伸器后装配能稳定膝关节的下肢补高矫形器行走。［结果］首次膝关节牵伸术后5a3个月随访，膝关节屈曲畸形完全

2、矫正，腓骨已出现胫骨化的趋势，腓骨头与股骨下端组成的膝关节已稳定在0°位，患肢配戴补高矫形器能徒手行走。［结论］膝关节牵伸技术，可有效的矫正先天性胫骨缺如伴发的屈膝畸形，安装带膝关节铰链的牵伸器，可将腓骨头与股骨下端控制于中立位，在长期生理性行走应力的刺激下，腓骨发生了胫骨样的变化，可发育成具有类似膝关节形态的结构，整个患肢由于正常的行走使用而得到良好发育。屈膝畸形；微关键词：先天性胫骨缺如创；Ilizarov;牵伸术Kneejointdistractionintreatmentofseverekneeflexion

3、deformitythatconcomitantcongenitalabsenceofthetibiaAbstract:[Objective]Theeffectsobservedfromtreatingseverekneef1exiondeformitywithconcomitantcongenitalabsenceofthetibiabydistractiontechnique[Method]Usingthefollowingmethodstotreatonepatientofcongenitalabsenceof

4、thetibiawithforkshapedlowerfemur,thecaputfibulaeformingunstablekneejoint,andconcomitantkneeflexion95degreeTreatitbylowerfemurreconstructionatone；installthellizarovapparatusat5and8separatelyBythetwosteps,distractandcorrectthekneeflexionatOdegreetoformkneejointwi

5、thcaputfibulaeandlowerfemurandtofitthelowerlimbbracewhichcanstabilizethekneejointafterthellizarovapparatusisdisassembled[Result]Atotalof63monthsfollowingupafterthefirstdistraction,thekneejointflexiondeformityisentirelycorrectedThefibulagraduallyformsthetibia,th

6、ekneejointwhichconstructedbycaputfibulaeandlowerfemurhasstabilizedatOdegreeThepatientcanwalkassembledwithhEightaddedorthopedicbrace[Conclusion]Thekneeflexiondeformitywithconcomitantcongenitalabsenceofthetibiacouldbecorinstallthekneedistractionapparatuswithjoint

7、hinge,thecaputfibulaeandlowerfemurcanbecontrolledtomedianlevelThefibulachangestotibia,andformsthestructurelikekneejointunderlongtermphysiologicalstimulativeofstressofwalkThelimbscangrowwellwhentheygetreasonableuseKeywords：Congenitalabsenceofthetibia；Kneeflexion

8、deformity；Minimalinvasion；Ilizarovdistractiontechnique先天性腔骨完全缺如（Jones分类Ia型），因同时缺乏伸膝动力和完整的膝关节结构，必然继发屈膝畸形和“膝关节”脱位，既往文献报告的治疗方法，皆采用截肢术后安装假肢，作者应用Ilizarov膝关节牵伸技术治疗1例，且经过8a8个月的治疗观察