Song Hae-Ryong, Myrboh Valencia, Oh Chang-Wug, Lee Sung-Tae, Lee Suk-Ha
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul.
Acta Orthop. 2005 Apr;76(2):261-9. doi: 10.1080/00016470510030670.
In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods.
We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients.
The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening.
The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening
在神经肌肉疾病中，肢体延长和足部畸形矫正与牵张性骨痂和关节挛缩相关的高并发症风险有关。我们未发现使用伊里扎洛夫方法或传统方法进行胫骨延长并同时矫正足部畸形的已发表文章。为了比较足部畸形合并胫骨延长时逐步牵张与三关节融合术的效果，我们研究了两种方法的愈合指数和并发症。
我们回顾了14例脊髓灰质炎后永久性畸形患者，他们使用伊里扎洛夫外固定器进行了胫骨延长并同时矫正足部畸形。3例患者在髓内钉上进行胫骨延长，11例患者未使用髓内钉进行延长。
无髓内钉时平均外固定时间为6（3.6 - 10）个月，有髓内钉时为1.6（1.5 - 1.7）个月，而无髓内钉时平均愈合指数为1.8（0.8 - 3.1）个月/厘米，有髓内钉时为2（1.8 - 2.3）个月/厘米。同时进行的足部治疗包括7例患者行三关节融合术，2例连枷踝患者行距下关节融合术，5例患者采用足部框架逐步牵张而不进行足部骨性手术。延迟愈合和踝关节反复马蹄足挛缩需要额外延长跟腱是胫骨延长过程中最常见的骨和关节并发症。
足部框架逐步牵张方法与主要并发症相关，如复发性足部畸形、关节脱位和关节炎。因此，我们建议在胫骨延长期间同时进行三关节融合术
