腓骨移植显微外科移位侧儿童踝关节畸形的预防
- 作者: Ryzhikov D.V.1, Vissarionov S.V.1
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隶属关系:
- H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
- 期: 卷 11, 编号 4 (2023)
- 页面: 501-506
- 栏目: Exchange of experience
- ##submission.dateSubmitted##: 21.07.2023
- ##submission.dateAccepted##: 01.11.2023
- ##submission.datePublished##: 20.12.2023
- URL: https://journals.eco-vector.com/turner/article/view/562772
- DOI: https://doi.org/10.17816/PTORS562772
- ID: 562772
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详细
论证。儿童的肌肉骨骼重建手术可能需要大量的自体移植物进行显微外科骨移植。传统的供体位置是取腓骨骨干部分。在术后晚期,这类患者可能会出现并发症,表现为供体腓骨缺损一侧的踝关节外翻畸形。
本研究旨在分析在儿童腓骨片游离移植替代肢体骨缺损后,预防踝关节外翻畸形的手术方法的有效性。
材料和方法。本研究分析了11名11至16岁患者(6名女孩和5名男孩)的治疗结果,这些患者使用腓骨干骺端自体移植物替代长管状骨缺损。2例患者因血源性骨髓炎导致股骨头缺损,2例患者为先天性股骨假关节,6例患者为先天性胫骨假关节,1例患者为先天性尺骨假关节。用髂骨自体移植物稳定切除的腓骨远端片段,其中8例在片段的干骺端水平,3例在干骺端水平。切除片段的大小占腓骨总长度的百分比和远端截骨的水平都在考虑之列。在手术后至少5年的时间内评估近端碎片移位的存在和大小以及踝间隙的位置。
结果。介入治疗5年及以上后,只有1名患者的腓骨远端碎片没有发生近端移位。其他10名患者的移位不超过3.5毫米。2名患者的踝关节内翻畸形与最初的踝关节内翻畸形相比超过5°。通过使用直径为4.0毫米的海绵状骨螺钉对胫骨远端骨骺进行临时半骺切除术,最长可持续16个月,从而防止其进展。外翻畸形无进展,降至原始值。
结论。在切除腓骨时,最好尽可能保留骨的远端部分;通过胫骨远端二骺区的合骨关节来改善踝关节的稳定性,而不尝试骨性内切。如果临床上出现明显的外翻畸形(与初始位置相比超过5°),且胫骨远端生长区的功能得以保留,则采用胫骨临时经骺半骨膜切除术进行矫正是最佳选择。
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作者简介
Dmitry V. Ryzhikov
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
编辑信件的主要联系方式.
Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN 代码: 7983-4270
MD, PhD, Cand. Sci. (Med.)
俄罗斯联邦, Saint PetersburgSergei V. Vissarionov
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930
MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS
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