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时间:2018-10-29
《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》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
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
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