跟腱挛缩的微创治疗.pdfVIP

·452 · 中国骨伤 2005 年 8 月第 18 卷第 8 期 　China J Ort hop Trauma ,Aug . 2005 ,Vol . 18 ,No . 8 ·临床研究 · 跟腱挛缩的微创治疗 张群 ,王岩 ,梁雨田,郭义柱 ,崔庚 (解放军总医院骨科 ,北京 　100853) 　　摘要 　目的:探讨应用 Ilizarov 踝关节牵伸器微创治疗跟腱挛缩的方法与疗效 。方法 :用 Ilizarov 踝 关节牵伸器治疗跟腱挛缩 9 例 ,手术时先将预先组装好的踝关节牵伸器套在小腿与足部 ,牵伸器的铰链 式关节对准踝关节的关节间隙 ,在小腿和足部各穿 2 组克氏针与牵伸器的钢环固定 。术后 4 d 开始调 整牵伸杆 ,直至踝关节达到中立位 ,并在此位置维持 4 周 。结果 :所有病例平均随访时间 12 个月 ,踝关 节平均保持在跖屈 3°位置 ,较术前平均改善 39°,踝关节活动范围平均 26°, 比术前平均进步 11°。无严重 并发症 ,行走功能明显改善 。结论 :Ilizarov 踝关节牵伸器微创治疗跟腱挛缩 ,能够避免一次性跟腱延长术 可能出现的踝关节后部跟腱外的皮肤缺损 。组织损伤小 ,并发症少 ,操作简便 ,安全可靠 ,疗效满意 。 关键词 　微创 ; 　外固定器 ; 　踝关节 ; 　跟腱挛缩 Minimal invasivc treatment f or contraction of Achilles tendon 　ZHA N G Q un , WA N G Yan , L IA N G Yu tian , GUO Yiz hu , CUI Geng . Dep art ment of Ort hop aedics , PL A General Hosp ital , B eij ing , 100853 , China Abstract 　Objective : To study t he technique and efficacy of Ilizarov retractor in t he minimal invasive treat ment for contraction of Achilles tendon . Methods :Nine p atient s wit h contraction of Achilles tendon were treated by Ilizarov retractors. The ankle retractors was assembled before surgery and put around leg and foot during t he op eration . The center of t he hinges of t he app aratus was pointed to t he joint sp ace firstly . Group s of Kirschner pin were p enetrated t hrough legs and anot her two group s t hrough feet and t hen fixed wit h t he steel rings of t he retractors. At t he fourt h day after op eration ,traction was p erformed by adj usting t he retractor until t he ankle reached t he neutral position . The retractor should hold ankle at t his position for four weeks. Results : All p atient s were followed up for a mean of 12 mont hs. The plantar flexion angle averaged 3 degrees after t he op eration and improved 39 degrees. The average range of motion of ankle reached 26 degree