Naudie D, Hamdy R C, Fassier F, Morin B, Duhaime M
Shriners Hospital for Crippled Children, Montreal, Quebec, Canada.
J Bone Joint Surg Br. 1997 Jan;79(1):58-65. doi: 10.1302/0301-620x.79b1.6602.
We reviewed retrospectively 22 patients (23 limb segments) with fibular hemimelia treated by amputation or limb lengthening to evaluate these methods of treatment. There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique. At the latest follow-up, the twelve patients who had amputation were functioning well and had few complications. The ten patients who had lengthening had suffered numerous complications, and all had needed either further corrective surgery or to wear braces or shoe-raises. Two of the ten lengthened limbs required late amputation for poor function or cosmesis. There were fewer hospital admissions, clinic visits, and periods of absence from school in the amputation group. Our findings suggest that amputation is a more effective method of management than limb-lengthening in severe fibular hemimelia. The Ilizarov method is an attractive alternative for selected patients, but its exact role is not yet established. One problem is that families often have unrealistic expectations of the surgical and prosthetic technology available and may refuse amputation when this has been recommended.
我们回顾性研究了22例（23个肢体节段）接受截肢或肢体延长治疗的腓骨半肢畸形患者，以评估这些治疗方法。其中有12名男孩和10名女孩，均伴有下肢相关畸形。12例患者（13个肢体节段）早期接受了截肢及假肢安装，10例采用伊里扎洛夫技术进行了胫骨延长。在最近的随访中，12例接受截肢的患者功能良好且并发症较少。10例接受延长手术的患者出现了许多并发症，且均需要进一步的矫正手术或佩戴支具或增高鞋。10例延长肢体中有2例因功能不佳或美观问题最终接受了截肢。截肢组的住院次数、门诊就诊次数及缺课时间均较少。我们的研究结果表明，对于严重的腓骨半肢畸形，截肢是比肢体延长更有效的治疗方法。伊里扎洛夫方法对部分选定患者来说是一种有吸引力的替代方法，但其确切作用尚未确定。一个问题是，家属往往对现有的手术和假肢技术抱有不切实际的期望，在建议截肢时可能会拒绝接受。
