Wahab Hussain, Fahad Shah, Noor-Us-Sabah Talal Aqueel, Mohib Yasir, Ur Rashid Haroon, Umer Masood
Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Ann Med Surg (Lond). 2019 Jul 8;45:40-44. doi: 10.1016/j.amsu.2019.07.006. eCollection 2019 Sep.
Deformities of the lower extremities can be congenital or acquired. Various surgical treatments have been employed for such disorders including osteotomy followed by either external fixation, internal fixation or external fixator assisted internal fixation. The aim of surgery is correction of deformity and restoration of mechanical axis and joint line. External fixator assisted internal fixation with intramedullary (IM) nail insertion is considered the gold standard, however, it is less commonly practiced as expertise required are usually not available at most centers. This study was conducted to assess the radiological and functional outcomes after fixator assisted IM nailing for correction of lower limbs deformity.
It was a retrospective study at a tertiary care hospital. All cases of lower limb deformity whose correction was done with fixator assisted IM nailing from 2010 till 2017 were analyzed. Pre Op x-rays and post op x rays were analyzed for Mechanical Axis Deviation (MAD), anatomical Lateral Distal Femoral Angle (aLDFA), mechanical Lateral Distal Femoral Angle (mLDFA) and Medial Proximal Tibial Angle (MPTA), post-operative activity and functional status of the patients. Data was analyzed using SPSS.
Thirteen patients were included in the study. Fixator assisted IM nailing was performed on 29 long bones of these patients including 16 femur and 13 tibial deformities. Pre Op and Post Op comparison was done for MAD, aLDFA, mLDFA, MPTA. Pre op mean MAD was 38.87 ± 25.58 post op mean MAD 17.54 ± 12.25 mm. Only 2 of our patients developed knee stiffness for which manipulation under anesthesia was done. One of our patients developed weakness in toe extension, which recovered after 6 months. On follow up evaluation patients had normal range of motion and no functional limitation.
Fixator assisted IM nailing for deformity correction is a better option, because it has advantages of both external fixator and internal fixator. Knee stiffness associated with external fixator can be prevented. It is more convenient for patient.
下肢畸形可分为先天性或后天性。针对此类病症已采用了多种外科治疗方法，包括截骨术，随后进行外固定、内固定或外固定器辅助内固定。手术目的是矫正畸形并恢复机械轴和关节线。外固定器辅助髓内（IM）钉插入的内固定被视为金标准，然而，由于大多数中心通常缺乏所需的专业技术，这种方法较少应用。本研究旨在评估外固定器辅助IM钉治疗下肢畸形后的影像学和功能结果。
这是一项在三级护理医院进行的回顾性研究。分析了2010年至2017年期间所有采用外固定器辅助IM钉进行矫正的下肢畸形病例。对术前X线片和术后X线片进行分析，以评估机械轴偏差（MAD）、解剖学外侧股骨远端角（aLDFA）、机械性外侧股骨远端角（mLDFA）和内侧胫骨近端角（MPTA），以及患者的术后活动和功能状态。使用SPSS软件对数据进行分析。
13名患者纳入本研究。对这些患者的29根长骨进行了外固定器辅助IM钉治疗，其中包括16例股骨畸形和13例胫骨畸形。对MAD、aLDFA、mLDFA、MPTA进行了术前和术后比较。术前平均MAD为38.87±25.58，术后平均MAD为17.54±12.25mm。我们的患者中只有2例出现膝关节僵硬，为此进行了麻醉下手法治疗。我们的1例患者出现趾背伸无力，6个月后恢复。随访评估显示患者活动范围正常，无功能受限。
外固定器辅助IM钉矫正畸形是一种更好的选择，因为它兼具外固定器和内固定器的优点。与外固定器相关的膝关节僵硬可以预防。对患者来说更方便。
