Wang Shiqi,Wang Yichen,Ying Hao,et al.Correction of lower limb deformities in children using Taylor spatial frame[J].Journal of Clinical Pediatric Surgery,,20():837-842.[doi:10.12260/lcxewkzz.2021.09.007]
Correction of lower limb deformities in children using Taylor spatial frame
- Keywords:
- Lower Extremity Deformities; Congenital/SU; Braces; Orthopedic Equipment; Treatment Outcome
- CLC:
- R726.826;R726.8
- Abstract:
- Objective To evaluate the clinical outcomes and correction accuracy of lower limb deformities in children using Taylor spatial frame (TSF).Methods From December 2016 to December 2018, 5 patients with lower limb deformities were treated with TSF.There were 1 boy and 4 girls with an average age of 8.2 years.There were idiopathic varus knee & lower limb deficiency (LLD, n=1), neurogenic clubfoot (n=1), posttraumatic varus knee & LLD (n=1), posttraumatic valgus ankle & LLD (n=1) and infective valgus knee and LLD (n=1).The preoperative full-length standing anterioposterior and lateral view films of ankle were taken.LLD, angulation, rotation and translation of deformity were evaluated and osteotomy levels designed accordingly.During operation, TSF was firstly mounted and reference ring perpendicular to reference bone.The mounting parameters were recorded followed by less invasive percutaneous osteotomy.The 6 struts were mounted according to the instruction after osteotomy was completely.Correction was started 7-10 days through adjusting the postoperative length of 6 struts following the time schedule generated by computer according to the mounting and deformity parameters.Radiographs were taken weekly during deformity correction.The struts were replaced when necessary.Results After frame adjusting for 35-42 days, 2 cases of deformities were fully corrected.Three cases of residual slight angulation or crispation deformity were fully corrected after a second/third 2-6 days frame adjusting.New bone formation and consolidation at osteotomy site were excellent.The fixators were removed at Month 1.5-6.0 post-operation.During a follow-up period of 6-29 months, there was no recurrence of deformity.One case of pin site infection was controlled by using sensitive antibiotics and alginate dressing.There was no onset of vascular and nerve injury, secondary clubfoot, ankylosis or refracture.Conclusion Idiopathic, neurogenic, posttraumatic and infective deformities may be effectively corrected by TSF with a high accuracy.TSF is ideal for correcting complicated deformities in children.
References:
1 Tsuchiya H,Uehara K,Abdel-Wanis ME,et al.Deformity correction followed by lengthening with the Ilizarov method[J].Clin Orthop Relat Res,2002,402:176-183.DOI:10.1097/00003086-200209000-00016.
2 Paley D.Principles of Deformity Correction[M].Springer,Berlin,2002:291-410.
3 Aronson J.Limb lengthening:skeletal reconstruction and bone transport with the Ilizarovmethod[J].J Bone Joint Surg Am,1997,79(8):1243-1258.DOI:10.2106/00004623-199708000-00019.
4 Manner HM,Huebl M,Radler C,et al.Accuracy of complex lower-limb deformity correction with external fixation:a comparison of the Taylor spatial frame withtheIlizarov ring fixator[J].J Child Orthop,2007,1(1):55-61.DOI:10.1007/s11832-006-0005-1.
5 Keshet D,Eidelman M.Clinical utility of the Taylor spatial frame for limb deformities[J].Orthop Res Rev,2017,9:51-61.DOI:10.2147/ORR.S113420.
6 刘红顺,周细作,康庆林.泰勒支架矫正踝关节周围畸形[J].中国矫形外科杂志,2018,26(7):663-666.DOI:10.3977/j.issn.1005-8478.2018.07.18. Liu HS,Zhou XZ,Kang QL.Application of Taylor spatial frame for deformity correction around ankle[J].Orthop J Chin,2018,26(7):663-666.DOI:10.3977/j.issn.1005-8478.2018.07.18.
7 张兴鹏,刘彦士,马信龙,等.计算机辅助设计应用于Taylor外固定支架行长骨骨折复位的效果[J].中华外科杂志,2018,56(10):786-792.DOI:10.3760/cma.j.issn.0529-5815.2018.10.017. Zhang XP,Liu YS,Ma XL,et al.Outcomes of computer-assisted design in the reduction of long bone fractures with Taylor spatial frame[J].Chin J Surg,2018,56(10):786-792.DOI:10.3760/cma.j.issn.0529-5815.2018.10.017.
8 Tsibidakis H,Panou A,Angoules A,et al.The role of Taylor spatial frame in the treatment of Blount disease[J].Folia Med (Plovdiv),2018,60(2):208-215.DOI:10.1515/folmed-2017-0082.
9 Megremis P,Megremis O.Bilateral Madelung wrist deformity in a 13-year-old girl:surgical correction with the Taylor spatial frame external fixation system[J].J Am Acad Orthop Surg Glob Res Rev,2019,3(11):e18.00036.DOI:10.5435/JAAOSGlobal-D-18-00036.
10 Tetsworth KD,Paley D.Accuracy of correction of complex lower-extremity deformities by the Ilizarov method[J].Clin Orthop Relat Res,1994,301:102-110.
11 Gantsoudes GD,Fragomen AT,Rozbruch SR.Intraoperative measurement of mounting parameters for the Taylor spatial frame[J].J Orthop Trauma,2010,24(4):258-262.DOI:10.1097/BOT.0b013e3181c2f7f0.
12 Naqui SZ,Thiryayi W,Foster A,et al.Correction of simple and complex pediatric deformities using the Taylor-Spatial Frame[J].J Pediatr Orthop,2008,28(6):640-647.DOI:10.1097/BPO.0b013e3181831e99.
13 Paloski M,Taylor BC,Iobst C,et al.Pediatric and adolescent applications of the Taylor spatial frame[J].Orthopedics,2012,35(6):518-527.DOI:10.3928/01477447-20120525-11.
14 Mayer SW,Hubbard EW,Sun D,et al.Gradual deformity correction in Blount disease[J].J Pediatr Orthop,2019,39(5):257-262.DOI:10.1097/BPO.0000000000000920.
15 Manggala Y,Angthong C,Primadhi A,et al.The deformity correction and fixator-assisted treatment using Ilizarov versus Taylor spatial frame in the foot and ankle[J].Orthop Rev (Pavia),2018,9(4):7337.DOI:10.4081/or.2017.7337.
16 Feldman DS,Shin SS,Madan S,et al.Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame[J].J Orthop Trauma,2008,17(8):549-554.DOI:10.1097/00005131-200309000-00002.
17 Rozbruch SR,Segal K,Ilizarov S,et al.Does the Taylor spatial frame accurately correct tibial deformities?[J].Clin Orthop Relat Res,2010,468(5):1352-1361.DOI:10.1007/s11999-009-1161-7.
18 Ganger R,Radler C,Speigner B,et al.Correction of post-traumatic lower limb deformities using the Taylor spatial frame[J].Int Orthop,2010,34(5):723-730.DOI:10.100-07/s0026409-0839-5.
19 Yilihamu Y,Keremu A,Abulaiti A,et al.Outcomes of post-traumatic tibial osteomyelitis treated with an Orthofix LRS versus an Ilizarov external fixator[J].Injury,2017,48(7):1636-1643.DOI:10.1016/j.injury.2017.05.002.
20 Maffulli N,Nele U,Matarazzo L.Changes in knee motion following femoral and tibial lengthening using the Ilizarov apparatus:a cohort study[J].J Orthop Sci,2004,6(4):333-338.DOI:10.1007/s007760100028.
Memo
收稿日期:2020-03-24。
基金项目:国家自然科学基金青年项目（编号：81401763），上海市自然科学基金面上项目（编号：20ZR1446600），上海交通大学医工交叉基金青年项目（编号：YG2021QN115）
通讯作者:赵利华,Email:zhaolh0803@163.com