先天性胫骨缺如伴重度膝关节屈曲畸形牵伸治疗1例.docVIP

先天性胫骨缺如伴重度膝关节屈曲畸形牵伸治疗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，牵拉矫正屈膝畸形达到伸膝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5 a 3个月随访，膝关节屈曲畸形完全矫正，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。 　　关键词：先天性胫骨缺如； 屈膝畸形； 微创； Ilizarov； 牵伸术 　　Knee joint distraction in treatment of severe knee flexion deformity that concomitant congenital absence of the tibia 　　Abstract：［Objective］The effects observed from treating severe knee flexion deformity with concomitant congenital absence of the tibia by distraction technique［Method］Using the following methods to treat one patient of congenital absence of the tibia with forkshaped lower femur,the caput fibulae forming unstable knee joint,and concomitant knee flexion 95 degreeTreat it by lower femur reconstruction at one;install the Ilizarov apparatus at 5 and 8 separatelyBy the two steps,distract and correct the knee flexion at 0 degree to form knee joint with caput fibulae and lower femur and to fit the lower limb brace which can stabilize the knee joint after the Ilizarov apparatus is disassembled［Result］A total of 63 months following up after the first distraction,the knee joint flexion deformity is entirely correctedThe fibula gradually forms the tibia,the knee joint which constructed by caput fibulae and lower femur has stabilized at 0 degreeThe patient can walk assembled with heightadded orthopedic brace［Conclusion］The knee flexion deformity with concomitant congenital absence of the tibia could be corrected efficiently by knee distraction techniqueAfter install the knee distraction apparatus with joint hinge,the caput fibulae and lower femur can be controlled to median levelThe fibula changes to tibia,and forms the structure like knee joint under longterm physiological sti