Cao Shu,Fang Ke,Xiao Sheng,et al.Ilizarov technique for the treatment of forearm deformities in hereditary multiple exostose[J].Journal of Clinical Pediatric Surgery,2021,20(11):1059-1063.[doi:10.12260/lcxewkzz.2021.11.012]
Ilizarov外固定架治疗尺骨骨干续连症的早期疗效分析
- Title:
- Ilizarov technique for the treatment of forearm deformities in hereditary multiple exostose
- Keywords:
- Ulna; External Fixators; Surgical Procedures; Operative; Child
- 分类号:
- R726.8;R683.416
- 摘要:
- 目的 探讨应用Ilizarov外固定架治疗儿童尺骨骨干续连症的早期疗效。方法 2014年2月至2017年2月,湖南省人民医院采用骨软骨瘤切除、Ilizarov外固定架延长尺骨术矫治17例尺骨骨干续连症患者,通过定期门诊复查及拍摄患肢X线片评估术后患肢畸形及功能改善情况。结果 17例术后平均随访30个月,尺骨平均延长26.99 mm;1例延长过程中出现钉道感染,通过口服抗生素及加强钉道护理治愈;1例拆除外固定架后发生尺骨延长段骨折,石膏固定后自行愈合;1例在末次随访时出现尺骨再发短缩。术后患者RAA、US、CS及腕关节、肘关节、前臂功能均得到改善。结论 应用骨软骨瘤切除、Ilizarov外固定架延长尺骨术治疗儿童尺骨骨干续连症早期效果满意。
- Abstract:
- Objective To explore the application of Ilizarov external fixation forearm deformities in hereditary multiple exostoses (HME). Methods From February 2014 to February 2017, 17 children with forearm deformities in HME underwent corrective osteotomy plus gradual lengthening of ulna by Ilizarov external fixation, corrective osteotomy of radius and excision of exostoses. The surgical outcomes and functional improvements of forearm were assessed via regular follow-ups and radiography. Results During an average follow-up period of 30 months, the average lengthening of ulna was 26.99 mm. One case of pin-track infection was properly controlled by pin care and oral antibiotics. Fracture occurred in one child after frame removal and healed after 4-week casting. And ulnar shortening re-occurred in another child at the last follow-up. The radiographic parameters of relative ulnar shortening (US), radial articular angle (RAA) and carpal slip (CS) improved. The postoperative functions of wrist, elbow and forearm all improved. Conclusion The treatment of forearm deformities in HME using the Ilizarov technique is efficacious during an early stage.
参考文献/References:
1 Li Y, Wang J, Wang Z, et al. A genotype-phenotype study of hereditary multiple exostoses in forty-six Chinese patients[J].BMC Med Genet, 2017, 18(1):126.DOI:10.1186/s12881-017-0488-2.
2 Solomon L.Hereditary multiple exostosis[J].Rocky Mt Med J, 1964, 74(2):119.DOI:10.3928/01477447-20131120-20.
3 Fogel GR, Mcelfresh EC, Peterson HA, et al. Management of deformities of the forearm in multiple hereditary osteochondromas[J].J Bone Joint Surg Am, 1984, 66(5):670-680.DOI:10.1007/BF00269920.
4 Masada K, Tsuyuguchi Y, Kawai H, et al. Operations for forearm deformity caused by multiple osteochondromas[J].J Bone Joint Surg Br, 1989, 71(1):24-29.DOI:10.1007/BF00268512.
5 Kok HK, Fitzgerald L, Campbell N, et al. Multimodality imaging features of hereditary multiple exostoses[J].Br J Radiol, 2013, 86(1030):20130398.DOI:10.1259/bjr.20130398.
6 Song SH, Lee H, Youssef H, et al. Modified Ilizarov technique for the treatment of forearm deformities in multiple cartilaginous exostoses:case series and literature review[J].J Hand Surg Euro, 2013, 38(3):288-296.DOI:10.1177/1753193412450651.
7 Ogden JA.Multiple hereditary osteochondromata:report of an early case[J].Clin Orthop Relat Res, 1976, 116(116):48-60.
8 Hecht JT, Hogue D, Strong LC, et al. Hereditary multiple exostosis and chondrosarcoma:linkage to chromosome Ⅱ and loss of heterozygosity for EXT-linked markers on chromosomes Ⅱ and 8[J].Am J Hum Genet, 1995, 56(5):1125-1131.
9 Litzelmann E, Mazda K, Jehanno P, et al. Forearm deformities in hereditary multiple exostosis:clinical and functional results at maturity[J].J Pediatr Orthop, 2012, 32(8):835.DOI:10.1097/BPO.0b013e3182694e40.
10 Clement ND, Porter DE.Forearm deformity in patients with hereditary multiple exostoses:factors associated with range of motion and radial head dislocation[J].J Bone Joint Surg Br, 2013, 95(17):1586-1592.DOI:10.2106/JBJS.L.00736.
11 Mader K, Gausepohl T, Pennig D.Shortening and deformity of radius and ulna in children:correction of axis and length by callus distraction[J].J Pediatr Orthop B, 2003, 12(3):183-191.DOI:10.1097/01.bpb.0000057485.91570.e9.
12 Akita S, Murase T, Yonenobu K, et al. Long-term results of surgery for forearm deformities in patients with multiple cartilaginous exostoses[J].J Bone Joint Surg Br Am, 2007, 89(9):1993-1999.DOI:10.2106/JBJS.F.01336.
13 Ip D, Li YH, Chow W, et al. Reconstruction of forearm deformities in multiple cartilaginous exostoses[J].J Pediatr Orthop B, 2003, 12(1):17-21.DOI:10.1097/01.bpb.0000043728.21564.0d.
14 Arms DM, Strecker WB, Manske PR, et al. Management of forearm deformity in multiple hereditary osteochondromatosis[J].J Pediatr Orthop, 1997, 17(4):450-454.DOI:10.1097/01241398-199707000-00007.
15 李玉婵, 陈博昌.骨延长术治疗儿童尺桡骨发育畸形的初步观察[J].中华小儿外科杂志, 2008, 29(3):156-158.DOI:10.3760/cma.j.issn.0253-3006.2008.03.008. Li YC, Chen BC.Treatment of ulnar and radial malformations by bone lengthening[J].Chin J Pediatr Surg, 2008, 29(3):156-158.DOI:10.3760/cma.j.issn.0253-3006.2008.03.008.
16 刘振江, 张立军, 马瑞雪, 等. 髂骨植骨尺骨延长治疗多发性骨软骨瘤前臂畸形的疗效评价[J].中国矫形外科杂志, 2005, 7(13):990-992.DOI:10.3969/j.issn.1005-8478.2005.13.009. Liu ZJ, Zhang LJ, Ma RX, et al. Effect of ilium wafting and ulna lengthening on the treatment of forearm deformity in heredity multiple osteochondroma[J].Orthop J Chin, 2005, 7(13):990-992.DOI:10.3969/j.issn.1005-8478.2005.13.009.
17 Shin EK, Jones NF, Lawrence JF.Treatment of multiple hereditary osteochondromas of the forearm in children:a study of surgical procedures[J].J Bone Joint Surg Br, 2006, 88(2):255-260.DOI:10.1302/0301-620X.88B2.16794.
18 Kelly JP, James MA.Radiographic outcomes of hemiepiphyseal stapling for distal radius deformity due to multiple hereditary exostoses[J].J Pediatr Orthop, 2016, 36(1):42-47.DOI:10.1097/BPO.0000000000000394.
19 张骥.尺骨延长治疗儿童骨干续连症的前臂畸形[J].临床小儿外科杂志, 2009, 8(6):36-38.DOI:10.3969/j.issn.1671-6353.2009.06.012. Zhang J.Efficacy of ulna lengthening for forearm deformity of hereditary multiple exostoses[J].J Clin Ped Sur, 2009, 8(6):36-38.DOI:10.3969/j.issn.1671-6353.2009.06.012.
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备注/Memo
收稿日期:2020-05-20。
基金项目:湖南省卫生健康委2020年度科研计划课题项目(编号:20200269)
通讯作者:方科,Email:714677831@qq.com