Huang S C
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, ROC.
J Formos Med Assoc. 1997 Apr;96(4):258-65.
Limb length discrepancy is common in patients with sequelae of poliomyelitis. However, treatment of this problem is difficult and complicated. From 1988 to 1993, 71 patients with sequelae of poliomyelitis were treated with leg lengthening by modifications of the Ilizarov technique. Their median age at surgery was 26.4 years (range, 11.6-38.1 yr). Patients were divided into four groups according to the method of treatment, with femoral lengthening in 18 patients, combined femoral and tibial lengthening in 6, tibial lengthening in 35, and tibial lengthening along and intramedullary locking nail in 12. At follow-up of 2 to 6.7 years, the combined femoral/tibial group had the greatest gain in length. Treatment time in the Ilizarov device was shortest in the tibial lengthening with locking nail group. The lengthening index, which was defined as days in the Ilizarov device required for each centimeter of lengthening (days/cm), was lowest in the tibial lengthening with locking nail group, followed by the combined femoral/tibial lengthening group. Complications such as soft tissue contracture, callus fracture and residual deformities were most common in the combined femoral/tibial lengthening group and the femoral lengthening group. Complications were least common in the tibial lengthening with locking nail group. The satisfaction rate was highest in the tibial lengthening with locking nail group. We found that in leg lengthening for patients with sequelae of poliomyelitis, callus maturation was slow, and patients tended to develop contractures despite physiotherapy, bracing or joint fixation. Concomitant and secondary surgery were frequently required to treat associated problems or residual deformities. Lengthening along an intramedullary locking nail can significantly shorten the treatment time with relatively few complications.
肢体长度不等在小儿麻痹后遗症患者中很常见。然而，这个问题的治疗困难且复杂。1988年至1993年，71例小儿麻痹后遗症患者采用改良的伊利扎罗夫技术进行肢体延长治疗。他们手术时的中位年龄为26.4岁（范围11.6 - 38.1岁）。根据治疗方法将患者分为四组，其中18例进行股骨延长，6例进行股骨和胫骨联合延长，35例进行胫骨延长，12例进行胫骨延长并植入髓内锁定钉。在随访2至6.7年时，股骨/胫骨联合延长组的长度增加最大。植入锁定钉的胫骨延长组在伊利扎罗夫器械中的治疗时间最短。延长指数定义为每延长1厘米在伊利扎罗夫器械中所需的天数（天/厘米），植入锁定钉的胫骨延长组最低，其次是股骨/胫骨联合延长组。软组织挛缩、骨痂骨折和残留畸形等并发症在股骨/胫骨联合延长组和股骨延长组中最为常见。植入锁定钉的胫骨延长组并发症最少。植入锁定钉的胫骨延长组满意度最高。我们发现，在小儿麻痹后遗症患者的肢体延长中，骨痂成熟缓慢，尽管进行了物理治疗、支具治疗或关节固定，患者仍容易出现挛缩。常常需要进行同期和二次手术来治疗相关问题或残留畸形。沿髓内锁定钉延长可显著缩短治疗时间，且并发症相对较少。
