屈膝畸形_____先天性胫骨缺如；_屈膝畸形；

先天性胫骨缺如伴重度膝关节屈曲畸形的牵伸治疗1例

http://www.100md.com 《中国矫形外科杂志》 2005年第21期

屈膝畸形,,先天性胫骨缺如；,屈膝畸形；,微创；,Ilizarov；,牵伸术,1病例摘要,2治疗过程,3治疗结果,4讨论,参考文献：

     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

    QIN Sihe,LI Chengxin,WU Hongfei,et al

    Orthopaedic Hospital,Chaoyang District,Beijing 100024

    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 forkshaped lower femur,the caput fibulae forming unstable knee joint,and concomitant knee flexion 95 degreeTreat it by lower femur reconstruction at one;install the Ilizarov apparatus at 5 and 8 separatelyBy 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 correctedThe fibula gradually forms the tibia,the knee joint which constructed by caput fibulae and lower femur has stabilized at 0 degreeThe patient can walk assembled with heightadded orthopedic brace[Conclusion]The knee flexion deformity with concomitant congenital absence of the tibia could be corrected efficiently by knee distraction techniqueAfter install the knee distraction apparatus with joint hinge,the caput fibulae and lower femur can be controlled to median levelThe fibula changes to tibia,and forms the structure like knee joint under longterm physiological stimulative of stress of walkThe limbs can grow well when they get reasonable use ......

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