中国修复重建外科杂志

中国修复重建外科杂志

有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症

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目的总结应用有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症的临床疗效,探讨中老年脊髓灰质炎后遗症外科矫正与功能重建策略。方法从秦泗河矫形外科团队 1982 年 9 月—2017 年 12 月手术治疗的 23 310 例脊髓灰质炎后遗症病例数据库中,检索出 41 岁以上患者 629 例,分析患者流行病学特点;并对其中 2011 年 3 月—2015 年 6 月应用有限手术结合外固定技术治疗的 57 例获完整随访患者的临床资料进行回顾分析。57 例患者脊髓灰质炎后遗症病史 41~67 年,平均 47.1 年。术前病理步态包括压股步态 29 例,扶拐行走 17 例,徒手跛行 11 例。手术方式包括跟腱延长术 52 例、股骨髁上截骨术 39 例、屈膝松解术 36 例、跟距关节融合术 27 例、屈髋松解术 21 例、胫腓骨截骨术 19 例、三关节融合术 11 例和肌腱转位术 1 例。术后应用组合式外固定器 18 例,应用 Ilizarov 环式外固定器 39 例。结果629 例患者中<50 岁 481 例(76.47%),51~65 岁 144 例(22.89%);其中 2003 年以后就诊患者 495 例(78.70%)。57 例获随访 2~6 年,平均 37 个月。牵拉矫形期间发生针道轻度感染 7 例,术后早期下肢静脉血栓形成 2 例,腓总神经不全麻痹 2 例。无皮肤切口感染、血管损伤与骨不愈合等并发症发生。末次随访时根据下肢畸形矫治术后疗效随访评价标准,获优 23 例、良 20 例、可 12 例、差 2 例,优良率 75.44%;2 例评价为差的患者经实施二次手术改善部分功能。结论有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症,能有效矫正下肢畸形与改善功能,延缓衰变所加重的残障,能规避严重并发症。

ObjectiveTo summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method.MethodsFrom the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator.ResultsOf the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function.ConclusionLimited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.

关键词: 有限矫形手术; 骨外固定技术; 中老年; 脊髓灰质炎后遗症

Key words: Limited orthopaedic operation; external fixation; middle and old age; poliomyelitis sequelae

引用本文: 秦泗河, 郭保逢, 郑学建, 焦绍锋, 臧建成. 有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症. 中国修复重建外科杂志, 2018, 32(10): 1249-1254. doi: 10.7507/1002-1892.201806022 复制

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