Qin Sihe, Guo Baofeng, Zheng Xuejian, Jiao Shaofeng, Zang Jiancheng
Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;Department of Orthopaedics, ChuiYiangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China.
Department of Orthopaedics, ChuiYiangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Oct 15;32(10):1249-1254. doi: 10.7507/1002-1892.201806022.
To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method.
From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator.
Of the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function.
Limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.
总结有限矫形手术联合外固定治疗中老年脊髓灰质炎后遗症下肢畸形的疗效，探讨手术矫正及功能重建方法。
从秦泗河矫形外科团队1982年9月至2017年12月治疗的23310例脊髓灰质炎后遗症病例数据库中，检索出629例41岁以上患者，分析患者的流行病学特征。2011年3月至2015年6月，对57例采用有限手术加外固定治疗的脊髓灰质炎后遗症患者进行2 - 6年随访，脊髓灰质炎后遗症病史41 - 67年（平均47.1年）。术前病理步态包括股四头肌步态29例、拄拐行走17例、仅间歇性跛行11例。手术方法包括跟腱延长52例、髁上截骨39例、膝关节屈曲松解36例、跟骨关节融合27例、屈曲位髋关节融合21例、胫腓骨截骨19例、三关节融合11例、肌腱移位1例。术后采用组合式外固定器治疗18例，Ilizarov环形外固定器治疗39例。
629例中，481例年龄小于50岁（76.47%），51至65岁144例（22.89%）。其中，495例（78.70%）于2003年后确诊。57例获得完整随访资料的患者中，牵引矫形期间针道轻度感染7例，术后早期下肢静脉血栓形成2例，腓总神经不完全麻痹2例。未发生皮肤切口感染、血管损伤、骨不连等并发症。根据下肢畸形矫正术后疗效评价标准，结果优23例，良20例，可12例，差2例，优良率75.44%。2例疗效差的患者再次手术改善功能。
有限矫形手术联合外固定治疗中老年脊髓灰质炎后遗症下肢畸形能有效矫正下肢畸形，改善功能，延缓因退变加重的残疾，避免严重并发症。
