Damsin J P, Carlioz H
Service d'Orthopédie et de Chirurgie Réparatrice de l'enfant, Hôpital Trousseau, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(4):324-33.
The numerous possibilities for adapting the Ilizarov apparatus allows the progressive correction of complex angular deviations, for which flat apparatus are sometimes difficult to adapt and this report describes our experience using the Ilizarov apparatus to treat axial limb deformities.
A total of 48 patients (22 girls and 26 boys aged between 2 and 18 years-old) suffering from 58 angular deformities were treated with an Ilizarov device. 40 of the deformities involved bones: 22 tibias, 13 femurs and 6 radius. The remaining 18 deformities involved joints, (17 knees and 1 elbow), 12 were total ankylosis and 6 were flexion contractures. 31 of the cases involved an isolated deformity (16 bones and 16 joints) and 27 were associated with other orthopedic problems. The cause of the deformities were either malformation or infection in most cases. In 39 cases the angular deformities were deviations in a single plane: 13 in two planes and 6 déformities were complex, involving deviation in all three planes. Correction was progressive in 49 cases and immediate in 9 cases. Unequal limb length was treated in 21 cases: 19 of these were caused by bone deformity. The apparatus should cover the entire bone segment to be corrected, from metaphysis to metaphysis. When the deformity is close to a joint, the joint should be bridged so as to stabilize the brace. The fastening of the sides of the deformity involves a maximum of three pins in two different planes. The apparatus must be absolutely rigid so as to avoid any lateral slipping or any movement of the rings relative to the segments of the limbs. The two parts of the apparatus fixed on either side of the deformity should be linked by two groups of three threaded rods with articulations at the ends. When the correction is in a single plane, it is effected around the axis formed by two threaded rods at the point of the deformity. When the deformity is major, 90 degrees or more, the rings tend to shift under the strain, and this leads to a loss of correction and cutaneous problems on the concave face. This may be avoided by fixing threaded rods to the ring, perpendicular to the plane of the deformity. For knee flexion contractures, the rods should be connected to the ring where it crosses the frontal plane passing through the femoral diaphysis.
48 angular deviations were completely corrected. In 10 cases the deformity persisted, but was less than 20 degrees. The deformity reoccurred in 6 of the children: in 3 cases due to the persistence of muscular imbalance, in two cases by assymetric growth, in the other case by plastic deformation on the insufficiently mineralized regenerated bone tissue formed during lengthening. In one case, the common, motor and sensor peroneal nerve was paralyzed, complicating the correction of an anterior dislocation of the knee. The paralysis occurred at the end of the correction and recovery began after 6 months. One 10 year old child, suffering from nail patela syndrome, was left with a completely immobilized elbow after treatment of a webbed, 100 degrees flexion contracture. A total of 9 epiphyseal separations (Salter I type) occurred during the correction of severe deformities, with little or no displacement, all occurred around the knee. These epiphyseal separations did not interfere with the treatment of the angular deviations in three cases, however, advantage was taken of these events to effect the intended lengthening of the bone.
The Ilizarov method for correcting joint ankylosis is difficult to perform, and depends on a detailed knowledge of the apparatus and braceing system, and requires rigourous installation of the pins, ring, joints and rods. Whatever the position of the two rings in relation to each other, it is always possible to link them by a system which can be adjusted. This is not possible with other external braces which have only a single plane.
伊利扎洛夫器械具有多种适应性，能够逐步矫正复杂的角度偏差，而平板器械有时难以适应这种情况。本报告描述了我们使用伊利扎洛夫器械治疗肢体轴向畸形的经验。
共有48例患者（22名女孩和26名男孩，年龄在2至18岁之间），患有58处角度畸形，接受了伊利扎洛夫器械治疗。其中40处畸形累及骨骼：22处胫骨、13处股骨和6处桡骨。其余18处畸形累及关节（17处膝关节和1处肘关节），12处为完全强直，6处为屈曲挛缩。31例为孤立畸形（16处骨骼和16处关节），27例与其他骨科问题相关。大多数情况下，畸形的原因是畸形或感染。39例角度畸形为单平面偏差：13例为双平面偏差，6例为复杂畸形，涉及所有三个平面的偏差。49例为逐步矫正，9例为即时矫正。21例治疗了肢体不等长：其中19例由骨畸形引起。器械应覆盖整个待矫正的骨段，从干骺端到干骺端。当畸形靠近关节时，应跨过关节以稳定支架。在畸形两侧固定时，最多在两个不同平面使用三根钢针。器械必须绝对坚固，以避免任何侧向滑动或环相对于肢体节段的任何移动。固定在畸形两侧的器械两部分应由两组三根螺纹杆连接，两端有关节。当矫正处于单平面时，围绕畸形点由两根螺纹杆形成的轴线进行矫正。当畸形较大，90度或更大时，环在应力下容易移位，这会导致矫正丢失和凹面皮肤问题。通过将螺纹杆垂直于畸形平面固定在环上，可以避免这种情况。对于膝关节屈曲挛缩，螺纹杆应连接到环与穿过股骨干的额平面相交处。
48处角度偏差得到完全矫正。10例畸形持续存在，但小于20度。6例儿童畸形复发：3例是由于肌肉失衡持续存在，2例是由于不对称生长，另1例是由于延长过程中形成的矿化不足的再生骨组织发生塑性变形。1例中，腓总神经运动和感觉功能麻痹，使膝关节前脱位的矫正复杂化。麻痹发生在矫正结束时，6个月后开始恢复。1例10岁患有指甲髌骨综合征的儿童，在治疗蹼状、100度屈曲挛缩的肘关节后，肘关节完全固定。在严重畸形矫正过程中，共发生9例骨骺分离（Salter I型），移位很少或无移位，均发生在膝关节周围。其中3例骨骺分离未干扰角度偏差的治疗，然而利用这些情况实现了预期的骨延长。
伊利扎洛夫矫正关节强直的方法操作困难，依赖于对器械和支具系统的详细了解，需要严格安装钢针、环、关节和螺纹杆。无论两个环彼此的位置如何，总是可以通过一个可调节的系统将它们连接起来。其他仅具有单平面的外部支具则无法做到这一点。
