Jasiewicz Barbara, Kacki Wojciech, Koniarski Arkadiusz, Kasprzyk Marcin, Zarzycka Maja, Tesiorowski Maciej
Uniwersytet Jagielloński, Collegium Medicum, Klinika Ortopedii i Rehabilitacji, Zakopane.
Ortop Traumatol Rehabil. 2002 Aug 30;4(4):413-20.
Background. Anisomelia in patients with congenital fibular deficiencies is a difficult orthopedic problem due to concomitant deformities of the angle and knee. The goal of the present study was to analyze outcomes of tibia lengthening in these patients. Material and methods. In the period 1989-2001 we performed lengthening of 26 limbs in 21 patients with congenital fibular deficiency (11 female, 10 male, average age 10.1 years). Under the Achterman-Kalamchi classification, 8 tibiae were Type 1, 3 were Type 1b, and 10 were Type 2 (including one case with bilateral defect). The average baseline shortening was 4.6 cm, i.e. 15.3%. The Ilizarov method was used in 24 cases, chondrial lengthening in the others. We measured time of lengthening, time of stabilization, total healing time, amount of lengthening, and the lengthening index, as well as the range of ankle and knee movement, the positioning of the foot, and the axis of the tibia at each stage. Problems and complications were classified according to Paley. The average follow-up was 4.9 years Results. The mean time of lengthening was 101 days, stabilization time 177 days, total healing time 269 days, mean lengthening 5.6 cm (22.9%). As of the last examination only 7 patients did not require follow-up surgery, 6 with Type 1a and 1 with Type 1b. Conclusions. Tibia lengthening with axis correction constitutes an alternative to amputation in congenital fibular deficiency. It is a difficult procedure, however, encumbered by a significant risk of complications.
背景。先天性腓骨缺如患者的肢体不等长是一个棘手的骨科问题，因为同时存在角度和膝关节畸形。本研究的目的是分析这些患者胫骨延长的效果。材料与方法。在1989年至2001年期间，我们对21例先天性腓骨缺如患者（11例女性，10例男性，平均年龄10.1岁）的26条肢体进行了延长手术。根据阿赫特曼 - 卡拉姆奇分类法，8例胫骨为1型，3例为1b型，10例为2型（包括1例双侧缺损）。平均基线短缩为4.6 cm，即15.3%。24例采用伊里扎洛夫方法，其余采用软骨延长术。我们测量了延长时间、稳定时间、总愈合时间、延长量和延长指数，以及踝关节和膝关节活动范围、足部位置和各阶段胫骨轴线。问题和并发症根据佩利进行分类。平均随访时间为4.9年。结果。平均延长时间为101天，稳定时间为177天，总愈合时间为269天，平均延长5.6 cm（22.9%）。截至最后一次检查，只有7例患者不需要后续手术，6例为1a型，1例为1b型。结论。伴有轴线矫正的胫骨延长术是先天性腓骨缺如患者截肢的一种替代方法。然而，这是一个困难的手术，存在显著的并发症风险。
