微创截骨Ilizarov技术联合髓内钉小腿延长与常规技术比较（开放获取）

Minimally invasive osteotomy Ilizarov technique combined with intramedullary nail versus conventional counterpart for leg lengthening

摘要:

[目的]探讨微创截骨 Ilizarov 技术联合髓内钉与常规技术矫正小腿短缩患者的临床疗效。[方法]回顾性分析 2013 年 5 月—2022 年 7 月本科采用 Ilizarov 技术矫正小腿短缩 51 例患者的临床资料。根据术前医患沟通结果，19 例接受微创截骨 Ilizarov 技术联合髓内钉 （改良组），另外 32 例采用传统 Ilizarov 技术延长 （常规组），比较两组围手术期、随访及影像结果。 [结果]两组患者均顺利完成手术。改良组的切口总长度 [(8.8±0.4) cm vs (1.9±0.2) cm, P＜0.001]、术中失血量 [(147.4±22.3) mL vs (25.9±4.1) mL, P＜0.001] 均显著多于常规组，而改良组的骨延长速度 [(1.80±0.11) cm/月 vs (1.83±0.12) cm/月, P=0.038]、外固定架佩戴时间 [(4.1±1.1) 周 vs (15.8±3.1) 周, P=0.008] 和总并发症发生率 [5 (26.3%) vs 25 (78.1%), P=0.002] 显著少于常规组。两组手术时间、术中透视次数、 外固定指数的差异均无统计学意义（P＞0.05）。所有患者随访平均（24.2±12.1）个月，两组恢复完全负重活动时间的差异无统计学意义 （P＞0.05）。与拆除外固定时相比，末次随访时，两组患者疼痛 VAS、HSS、AOFAS 评分及膝 ROM、踝 ROM 均显著改善 （P＜0.05）。末次随访时，改良组的膝 ROM [(112.6±10.1)° vs (89.4±5.7)°, P=0.005]、踝 ROM [(31.6± 4.1)° vs (15.3±3.8)°, P＜0.001] 均显著优于常规组。影像方面，末次随访时，除改良组双侧胫骨长度差 [(2.6±1.0) mm vs (4.8±1.0) mm, P＜0.001] 显著小于常规组外，其他相应时间点，两组间双侧胫骨长度差、胫骨冠状面畸形、胫骨矢状面畸形、胫骨近端内侧角 （medial proximal tibial angle, MPTA） 的差异均无统计学意义 （P＞0.05）。[结论] 微创截骨 Ilizarov 技术结合髓内钉技术小腿延长，缩短了患者佩戴外固定器的时间，优化了术后膝踝关节的功能。

Abstract:

[Objective] To explore the clinical efficacy of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail versus conventional Ilizarov technique for correcting leg shortening. [Methods] A retrospective research was conducted on 51 patients who underwent Ilizarov technique for leg shortening in our department from May 2013 to July 2022. According to preoperative doctorpatient communication, 19 patients received minimally invasive osteotomy Ilizarov technique combined with intramedullary nail (the modified group), while the other 32 patients were treated with traditional Ilizarov technique for leg lengthening (the conventional group). The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All patients in both groups had the corresponding surgical procedures performed successfully. The modified group consumed significantly longer total incision length [(8.8±0.4) cm vs (1.9±0.2) cm, P＜0.001] and more intraoperative blood loss [(147.4±22.3) mL vs (25.9±4.1) mL, P＜0.001] than the conventional group, while the former proved significantly superior to the latter in terms of the bone lengthening speed [(1.80±0.11) cm/month vs (1.83±0.12) cm/ month, P=0.038], external fixation frame wearing time [(4.1 ± 1.1) weeks vs (15.8 ± 3.1) weeks, P=0.008] and total complication rate [5 (26.3%) vs 25 (78.1%), P=0.002]. There were no statistically significant differences in operation time, intraoperative fluoroscopy times and external fixation index between the two groups (P＞0.05). All patients were followed up for (24.2±12.1) months in a mean, and there was no a statistically significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). Compared with that at the time of removing the external fixator, the pain VAS, HSS, AOFAS scores and knee range of motion (ROM), ankle ROM were significant-y improved in both groups at the last follow-up (P＜0.05). At the last follow-up, the modified group was significantly better than the conventional group in terms of knee ROM [(112.6±10.1) ° vs (89.4±5.7) °, P=0.005] and ankle ROM [(31.6±4.1) ° vs (15.3±3.8) °, P＜0.001]. As for imaging, although there were no statistically significant differences in tibial coronal plane deformity, tibial sagittal plane deformity, and medial proximal tibial angle (MPTA) at other corresponding time points between the two groups (P＞0.05), the modified group was also significantly better than the conventional group regarding the bilateral tibial length discrepancy at the latest follow-up [(2.6±1.0) mm vs (4.8±1.0) mm, P＜0.001]. [Conclusion] This minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for leg lengthening does shorten the external frame wearing time and optimizes the function of knee and ankle joints after surgery.