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股骨下端 L 形截骨一次性和逐渐性相结合延长治疗股骨短缩畸形 |
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杨述华 刘国辉 李进 许伟华
【摘要】 目的 解决一次性延长因血管、神经等并发症难以达到延长目的，而逐渐性延长治疗时间持续太长等问题。方法 在股骨下干骺端行“L”形截骨，术中延长2～3 cm，剩余部分术后继续逐渐延长。结果 18例延长的长度为3.0～8.5 cm（平均6.4 cm）。步态正常者9例，膝关节活动正常8例。平均住院日为34.5天，远低于逐渐性延长组56.7天。 结论 一次性和逐渐性相结合延长的方法并发症少、治疗疗程明显缩短，是较理想的截骨延长方法。
【关键词】 股骨短缩； 腿长不等； 骨延长术
【中图分类号】 R682.6; R687.3
“L” osteotomy of distal femur with once and gradually lengthening of femur for femoral shortening
Yang Shuhua, Liu Guohui, Li Jin, Xu Weihua
(Department of Orthopaedics, Union Hospital of Tongji Medical University, Wuhan，Hubei 430022)
【Abstract】 Objective Because of problem of the blood-vessel and nerve, once lengthening is difficult to achieve the aim of limb lengthening. Morever hosiptalization time of the gradually lengthening is too long. The technique was developed for overcoming the problem. Methods An improved method of “L” osteotomy once and gradually lengthening was developed. 2～3 cm lengthening was produced in operation immediately and surplus lengthening kept making after operation. Results 18 patients obtained satisfactory results, 9 patients demonstrated correct steps and 8 patients showed normal knee joint activity. The lengthening was 3.0～8.5 cm (average 6.4 cm). The average hospitalization time was only 34.5 days, far fewer than group of gradually lengthening(56.7 days). Conclusion Once lengthening combined with gradually lengthening is beneficial to patients because of fewer complications and short treatment course.
【Key words】 femur shortening; leg length inequality; bone lengthening
骨干截骨一次性植骨延长是常用的一种肢体延长术，但由于血管、神经不能耐受很难达到预期延长目的，逐渐性延长存在治疗时间持续太长、患者负担太重等缺点。我院骨科自1991～1997年采用自行设计的股骨下干骺端“L”形截骨一次性和逐渐性相结合延长治疗股骨短缩畸形18例，获得满意效果。
1 材料与方法
1.1 病例资料 本组共18例，男12例，女6例，年龄8～15岁。病因：股骨下端外伤性骨骺早闭11例，股骨下端病理性骨骺早闭4例，小儿麻痹后遗症3例。右侧12例，左侧6例。短缩的长度为5～9 cm（平均6.7 cm）。
1.2 手术延长方法 在大腿下段外侧纵切口，将骨膜作环形剥离5～8 cm左右，呈袖状，这种较大范围剥离骨膜可使其延长时不至撕[1] [2] 下一页
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