Yadav Surender Singh
Orthopaedic Surgery, Mirpur Institute of Medical Sciences (MIMS), VPO-Mirpur, Rewari, Haryana, 122502, India.
Int Orthop. 2024 Aug;48(8):2073-2081. doi: 10.1007/s00264-024-06183-8. Epub 2024 May 7.
Management of fibular hemimelia includes either prosthetic care with or without a suitable amputation or tibial lengthening. Many studies have documented the success of both procedures. Most parents of these children refuse an amputation or have no access to good prosthetic care. The author presents a limb-salvage procedure with tibial lengthening and ankle stabilization.
Twelve children of fibular hemimelia with 14 extremities had been subjected to limb lengthening after lateral leg release. To correct the valgus procurvatum, double oblique diaphyseal osteotomy (DODO) of the tibia was performed in 11 extremities. The age of the patients ranged from two to 15 years with the median of five years. All were male. The proposed procedure included three stages of loosening, lengthening, and stabilization with ankle arthrodesis at a later stage.
All patients returned for follow-up for the first four years and had been walking on their sensate feet. With DODO followed by fixator/traction could straighten and lengthen the tibia simultaneously and correct the valgus procurvatum. Ankle stabilization provided stability and a plantigrade foot. A follow-up of six to 30 years with a median of ten years has been reported.
A new procedure of loosening, lengthening, and stabilization of the leg with ankle arthrodesis has been proposed. A follow-up of 30 years with a median of ten years of the said procedure has been reported. The procedure provides a long-lasting plantigrade and painless foot that has sensation and proprioception. An amputation at any level has not been recommended.
腓骨半肢畸形的治疗方法包括使用或不使用合适截肢术的假肢护理，或胫骨延长术。许多研究都记录了这两种手术的成功案例。这些患儿的大多数家长拒绝截肢，或者无法获得良好的假肢护理。作者介绍了一种通过胫骨延长和踝关节稳定化来保肢的手术方法。
12例患有腓骨半肢畸形的儿童共14条肢体，在进行小腿外侧松解后接受了肢体延长术。为矫正膝外翻前凸，11条肢体的胫骨进行了双斜骨干截骨术（DODO）。患者年龄从2岁至15岁不等，中位数为5岁。均为男性。所提议的手术包括三个阶段：松解、延长，后期进行踝关节融合以实现稳定化。
所有患者在前四年均返回进行随访，且均能用有感觉的脚行走。采用DODO并结合固定器/牵引可同时矫正胫骨并延长，还能矫正膝外翻前凸。踝关节稳定化提供了稳定性和跖行足。已报道了6至30年的随访情况，中位数为10年。
提出了一种对腿部进行松解、延长并结合踝关节融合实现稳定化的新手术方法。已报道了对该手术方法进行的中位数为10年、长达30年的随访情况。该手术方法可提供持久的跖行且无痛的脚，具备感觉和本体感觉。不建议在任何水平进行截肢。
