Cattaneo R, Catagni M A, Guerreschi F
Centre Ilizarov, Hôpital de Lecco, Italie.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Sep;87(5):443-50.
Typical cases of lateral longitudinal hemimelia of the upper limb are characterized by agenesia of the radius and the thumb. The hand has four fingers and due to the lack of a radius, deviates laterally beyond 90 degrees. The ulna is short in 50 to 60% of the cases. Hand function is very limited causing a major handicap in everyday life activities. We report here the long-term outcome of 14 patients treated with the Ilizarov method.
Fourteen cases in thirteen patients, mean age 14.8 years, with radial hemimelia (one bilateral surgery) were treated with the Ilizarov method between June 1981 and December 1998 at the Lecco Hospital, Italy. Currently, the circular frame is composed of 3 elements: a half ring fixed by pins and wires to the metacarpal bones, 2 rings with pins and wires in the ulna, and 2 hinge clamps between the half-ring and the first distal ring to center the hand on the ulna by applying a lateral force. After centering the hand, the procedure continues with an ulnocarpal arthrodesis and is terminated by a proximal osteotomy of the ulna for forearm lengthening.
Patients were followed for 1 to 16 years. A last follow-up, hand function was excellent in 2 cases, good in 1, average in 10 and poor in 1. The esthetic result was excellent in 6, good in 6 and average in 2.
These results demonstrate that excellent stability of the hand centered on the ulna and forearm lengthening can be achieved with the new hybrid and more stable Ilizarov circular fixation method. Surgeons should become more familiar with this new instrumentation and its use.
上肢外侧纵向半肢畸形的典型病例表现为桡骨和拇指发育不全。手部有四根手指，由于缺少桡骨，向外侧偏斜超过90度。在50%至60%的病例中尺骨较短。手部功能非常有限，给日常生活活动带来严重障碍。我们在此报告14例采用伊里扎洛夫方法治疗的患者的长期疗效。
1981年6月至1998年12月期间，意大利莱科医院对13例患者中的14例（1例双侧手术）桡骨半肢畸形患者采用伊里扎洛夫方法进行治疗，平均年龄14.8岁。目前，环形外固定架由3个部件组成：一个通过针和钢丝固定在掌骨上的半环，尺骨上带有针和钢丝的2个环，以及半环与第一个远端环之间的2个铰链夹，通过施加侧向力使手部以尺骨为中心。手部对中后，接着进行尺腕关节融合术，最后通过尺骨近端截骨术延长前臂来结束手术。
患者随访1至16年。最后一次随访时，手部功能优2例，良1例，中10例，差1例。美学效果优6例，良6例，中2例。
这些结果表明，采用新型混合且更稳定的伊里扎洛夫环形固定方法能够实现以尺骨为中心的手部的出色稳定性以及前臂延长。外科医生应更加熟悉这种新器械及其使用方法。
