Schoenecker P L, Capelli A M, Millar E A, Sheen M R, Haher T, Aiona M D, Meyer L C
Shriners Hospital for Crippled Children, St. Louis, Missouri 63131.
J Bone Joint Surg Am. 1989 Feb;71(2):278-87.
Fifty-seven patients (seventy-one limbs) who had congenital longitudinal deficiency of the tibia (tibial hemimelia) were retrospectively categorized according to radiographic type (Types 1 through 4, as described by Jones et al.). At an average follow-up of nine years, fifty-six of fifty-seven patients walked independently. An ablative surgical procedure was performed on sixty-one of the seventy-one lower extremities. According to the classification of Jones et al., fifty-four limbs had a Type-1 (a or b) or Type-2 deficiency. In twenty-two of these extremities, disarticulation of the knee was performed; in twenty-five, a Syme amputation; and in one, a Chopart amputation. The ipsilateral foot was retained in six extremities that had a severe Type-1 or Type-2 deficiency. Medial transfer of the fibula (the Brown procedure) generally yielded less than satisfactory results; in ten of fourteen extremities, one or more additional operations were needed. Seventeen extremities were classified as having a Type-3 or Type-4 deficiency; Syme amputation was done in nine and Chopart amputation, in four. Despite satisfactory reconstruction of the ankle, a Syme amputation was necessary in most extremities that had a Type-4 deficiency because a major leg-length discrepancy was projected. In four limbs that had a Type-3 or Type-4 deficiency, the foot was retained.
对57例（71条肢体）先天性胫骨纵向缺损（半侧胫骨发育不全）患者，根据影像学类型（Jones等人描述的1至4型）进行回顾性分类。平均随访9年时，57例患者中有56例可独立行走。71条下肢中的61条进行了截肢手术。根据Jones等人的分类，54条肢体为1型（a或b）或2型缺损。在其中22条肢体上进行了膝关节离断术；25条进行了Syme截肢术；1条进行了Chopart截肢术。6条患有严重1型或2型缺损的肢体保留了同侧足部。腓骨内侧移位术（Brown手术）的效果通常不尽人意；14条肢体中有10条需要进行一次或多次额外手术。17条肢体被归类为3型或4型缺损；9条进行了Syme截肢术，4条进行了Chopart截肢术。尽管踝关节重建效果良好，但大多数4型缺损的肢体仍需进行Syme截肢术，因为预计会出现较大的下肢长度差异。4条3型或4型缺损的肢体保留了足部。
