Department of Orthopaedic Surgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, China.
Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, China.
Orthop Surg. 2024 Sep;16(9):2252-2263. doi: 10.1111/os.14215. Epub 2024 Sep 7.
The principles of limb reconstruction are crucial for treatment success, but there is no unified standard for complex limb deformities. The aim of this study was to analyze the characteristics of the cases of post-traumatic lower limb deformity and explore the new principle of limb reconstruction.
A retrospective analysis was conducted of 148 patients with post-traumatic lower limb deformity who underwent surgery from May 1978 to December 2023; 85 were males (57.4%) and 63 were females (42.6%); 65 cases of left side (43.9%), 79 cases of right side(53.4%), and 4 cases were on both sides (2.7%), the average age was 24.64 years (5-69). There were 4 cases suffering hip deformities, 40 cases of femoral deformities, 18 cases from knee, 40 cases from tibiofibular, 93 cases of foot and ankle deformities, and some patients also had two or more types. All patients underwent surgical intervention in an average of 40.5 months (12-96) after injury. According to the evaluation of limb deformities, deformity correction and functional reconstruction with external fixation were implemented, following the principle of "one walking, two lines, and three balances." The clinical evaluation adopts the criteria of Qinsihe lower limb deformity correction and functional reconstruction.
148 patients with post-traumatic lower limb deformities were followed up for 40.9 (12-356) months. The main surgical procedures implemented were tendon lengthening and soft tissue release (84 cases), osteotomy (93 cases), joint fusion (30 cases), and tendon transposition (16 cases); there were multiple surgical procedures in some patients. Among them, 124 cases used external fixators for stress control and 27 cases used internal fixation, while 3 cases used plaster or brace. There were 5 wire reactions postoperatively, which improved after dressing change and oral antibiotics. There were 2 pin infections, which improved by pin removing. No surgical related deep infections occurred, and no surgical related neurovascular damage occurred. At the last follow-up, all limb deformities were corrected, limb function improved, and the results of treatment was very satisfactory. According to Qinsihe evaluation criteria for lower limb deformities, 74 cases were excellent, 56 cases good, and 18 cases fair, with an excellent and good rate of 87.84%.
Stress control with external fixation is effective, safe, and controllable in correcting and reconstructing post-traumatic lower limb deformities. The principle of "one walking, two lines, and three balances" plays an important role in the entire process of stress control limb reconstruction.
肢体重建的原则对于治疗的成功至关重要，但对于复杂的肢体畸形尚无统一的标准。本研究旨在分析创伤后下肢畸形病例的特点，并探讨肢体重建的新原则。
回顾性分析 1978 年 5 月至 2023 年 12 月期间收治的 148 例创伤后下肢畸形患者的临床资料，男 85 例（57.4%），女 63 例（42.6%）；左侧 65 例（43.9%），右侧 79 例（53.4%），双侧 4 例（2.7%）；年龄 569 岁，平均 24.64 岁。4 例合并髋部畸形，40 例合并股部畸形，18 例合并膝部畸形，40 例合并胫腓骨畸形，93 例合并足踝部畸形，部分患者同时存在两种或两种以上类型畸形。所有患者伤后平均 40.5 个月（1296 个月）接受手术干预。根据肢体畸形的评估，采用外固定架进行畸形矫正和功能重建，遵循“一走路、两线、三平衡”的原则。临床评估采用秦泗河下肢畸形矫正与功能重建疗效评价标准。
148 例创伤后下肢畸形患者获得 40.9（12~356）个月的随访。主要手术方式包括肌腱延长和软组织松解 84 例，截骨术 93 例，关节融合术 30 例，肌腱转位术 16 例；部分患者行 1 次以上手术。其中 124 例行外固定架应力控制，27 例行内固定，3 例行石膏或支具固定。术后发生 5 例钢针反应，经换药、口服抗生素后好转。发生 2 例钉道感染，经拔钉后好转。无手术相关深部感染发生，无手术相关神经血管损伤发生。末次随访时，所有患者肢体畸形均得到矫正，肢体功能改善，治疗效果非常满意。根据秦泗河下肢畸形疗效评价标准，优 74 例，良 56 例，可 18 例，优良率为 87.84%。
外固定架应力控制矫正重建创伤后下肢畸形有效、安全、可控。“一走路、两线、三平衡”原则在整个应力控制肢体重建过程中发挥重要作用。
