Eamsobhana Perajit, Kaewpornsawan Kamolporn
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S62-9.
To study the results of treatment of tibial hemimelia with limb salvage procedure in term of patient satisfaction, clinical results and complications.
From 1993 to 2007 the authors treated six cases of tibial hemimelia with limb salvage procedures. Three legs of type Ia and four legs of type IV tibial hemimelia classified by Jones classification. The age at the operation ranged from 2 to 11 years. For type Ia cases, the Brown procedure,foot centralization and ilizarov lengthening of the fibula were used to correct limb length discrepancy. For type IV the foot centralization, soft tissue release and ilizarov lengthening were used to correct limb length discrepancy. The follow-up range from 4 to 10 years.
In two patients with type Ia, one patient could bear weight without gait aids, the other walked with orthosis and axillary crutch because this patient had bilateral Ia type and knee instability with progressive flexion contracture due to weakness of the quadriceps muscle. All patients with type IV can walk independently without gait aids. Three patients were performed limb lengthening. One case was fibular lengthening following Brown procedure in Ia type. Two cases were tibial lengthening in type IV The mean lengthening was 5.1 cm. Mean lengthening index was 2.4. Satisfactory functional and cosmetic results were achieved in all patients with partial deficiency, whereas in patients with completely deficiency of the limbs, none of the 3 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture and persistent ligamentous instability. Nevertheless, in these 3 legs, all patients were ultimately able to withstand weight bearing.
Patients and families were satisfied even though patients must have multiple surgery to correct deformities of the foot and the knee joint, as well as leg-length discrepancy and also a prolong treatment time. Limb salvage procedure in tibial hemimelia is appropriate in Thai culture because patients can weight with bare feet in the house and have sensation in the feet.
从患者满意度、临床疗效及并发症方面研究保肢手术治疗胫骨半侧肢体发育不全的结果。
1993年至2007年，作者采用保肢手术治疗6例胫骨半侧肢体发育不全患者。根据琼斯分类法，Ia型3例，IV型4例。手术年龄为2至11岁。对于Ia型病例，采用布朗手术、足部中心化及腓骨Ilizarov延长术纠正肢体长度差异。对于IV型病例，采用足部中心化、软组织松解及Ilizarov延长术纠正肢体长度差异。随访时间为4至10年。
2例Ia型患者中，1例无需助行器即可负重行走，另1例因双侧Ia型且股四头肌无力导致膝关节不稳定并逐渐出现屈曲挛缩，需佩戴矫形器及腋拐行走。所有IV型患者均可独立行走而无需助行器。3例患者接受了肢体延长术。1例Ia型患者在布朗手术后进行了腓骨延长。2例IV型患者进行了胫骨延长。平均延长长度为5.1cm。平均延长指数为2.4。所有部分肢体缺损的患者均取得了满意的功能和美容效果，而在肢体完全缺损的患者中，3例接受腓骨转移治疗的膝关节均未获得满意的功能效果，原因是股四头肌力量不足、膝关节屈曲挛缩逐渐加重及韧带持续不稳定。然而，在这3条腿中，所有患者最终均能耐受负重。
尽管患者必须接受多次手术来纠正足部和膝关节畸形、肢体长度差异以及延长治疗时间，但患者及其家属仍感到满意。在泰国文化中，胫骨半侧肢体发育不全的保肢手术是合适的，因为患者可以在家中赤脚负重且足部有感觉。
