Xie Shuqiang, Hou Jianxi, Dong Qiqiang, Zhang Huafeng, Wang Hongxin, Yang Chaofan
Department of Trauma Orthopedics, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000,
Department of Trauma Orthopedics, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Aug 15;31(8):936-940. doi: 10.7507/1002-1892.201703069.
To investigate the effectiveness and technical points of shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg.
Twelve cases of severe amputation of middle and distal lower leg were treated with shortened replantation at the 1st stage and limb lengthening at the 2nd stage between April 2009 and May 2016. There were 9 males and 3 females with an average age of 28 years (range, 16-32 years). The injury causes included traffic accident injury in 4 cases, heavy pound injury in 6 cases, and machine crush injury in 2 cases. The interval from injuries to treatment ranged from 30 minuts to 6 hours (mean, 3 hours and 12 minutes). All of 12 cases, 6 cases were completely amputated in the right middle and distal lower leg, 4 were not completely amputated in the left middle and distal lower leg, and 2 were ankle amputations. The limbs were 4.0-12.5 cm shorter than the contralateral sides, with an average of 7.3 cm. Limb lengthening was performed at 1.5-8.0 months after replantation and the time of extension was 1.7-5.3 months (mean, 3.1 months).
All 12 patients recovered the same lengths of both lower extremities after shortened replantation and limb lengthening. The lengthened segments gained good bone mineralization, bony union was achieved at lengthened segments and broken end of fracture at 7-16 months (mean, 11.3 months). All patients were followed up 6 months to 5 years (mean, 2 years and 5 months). The range of motion of the knee joint were 0-5° (mean, 3°) in hyperextension and 110-140° (mean, 120°) in flexion. Except for 2 cases of ankle arthrodesis, plantar flexion angles were 15-45° (mean, 26°) and dorsiflexion angles were 10-25° (mean, 15°) in the other cases. The plantar sensation was restored to the S level in 4 cases, S level in 6 cases, and S level in 2 cases. At last follow-up, the affected limb function were excellent in 7 cases, good in 3 cases, fair in 2 cases according to Kofoed functional evaluation criteria.
It expanded indications for replantation of lower limb amputation, reduced the operation difficulty and trauma with shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg.
探讨小腿中下段严重离断伤采用缩短再植联合肢体延长术治疗的疗效及技术要点。
2009年4月至2016年5月，对12例小腿中下段严重离断伤患者行一期缩短再植、二期肢体延长术。男9例，女3例，平均年龄28岁（16～32岁）。致伤原因：交通事故伤4例，重物砸伤6例，机器绞伤2例。受伤至手术时间为30分钟至6小时（平均3小时12分钟）。12例中，右小腿中下段完全离断6例，左小腿中下段不完全离断4例，踝关节离断2例。伤肢较健侧短4.0～12.5 cm，平均7.3 cm。再植后1.5～8.0个月行肢体延长术，延长时间为1.7～5.3个月（平均3.1个月）。
12例患者经缩短再植及肢体延长术后双下肢等长。延长段骨矿化良好，延长段及骨折断端于7～16个月（平均11.3个月）达到骨性愈合。所有患者随访6个月至5年（平均2年5个月）。膝关节过伸活动度为0～5°（平均3°），屈曲活动度为110～140°（平均120°）。除2例行踝关节融合术外，其余患者跖屈角度为15～45°（平均26°），背伸角度为10～25°（平均15°）。足底感觉恢复至S₃级4例，S₄级6例，S₅级2例。末次随访时，根据Kofoed功能评价标准，患肢功能优7例，良3例，可2例。
缩短再植联合肢体延长术治疗小腿中下段严重离断伤，扩大了下肢断肢再植的适应证，降低了手术难度及创伤。
