基于CT数据六轴外固定架与内固定在矫正胫骨畸形中的应用

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摘要目的探讨基于CT数据六轴外固定架与内固定矫正胫骨畸形的临床疗效。方法回顾性分析2019年1月至2023年1月接受胫骨畸形矫正的60例患者的临床资料，根据术式选择分为内固定组30例，外固定架组30例。内固定组男9例，女21例；平均年龄(32.83±7.73)岁。外固定架组男15例，女15例；平均年龄(31.17±8.43)岁。比较两组患者的手术情况、截骨处愈合时间、术后并发症发生情况及术后随访的影像学测量指标。结果两组患者均获随访，随访时间6~15个月，平均(6.97±1.69)个月。与内固定组比较，外固定架组的切口长度更短(P＜0.05)，截骨处愈合时间较长(P＜0.05)；在手术时间、出血量、下地时间、住院时间、并发症方面，两组差异无统计学意义(P＞0.05)；术前两组的机械轴偏移(mechanical axis deviation，MAD)、股胫角(femoro tibial angle，FTA)、胫骨近端内侧角(medial proximal tibial angle，MPTA)、胫骨远端外侧角(lateral distal tibial angle，LDTA)、股骨远端外侧角(lateral distal femoral angle，LDFA)、关节线相交角(joint line convergence angle，JLCA)、双下肢长度差(leg length discrepancy，LLD)差异无统计学意义(P＞0.05)；术后两组的FTA、MPTA、LDTA、LDFA、JLCA差异无统计学意义(P＞0.05)，外固定架组的MAD、LLD小于内固定组，差异有统计学意义(P＜0.05)；与术前比较，内固定组术后的MAD、FTA、MPTA、LDTA、JLCA差异有统计学意义(P＜0.05)，外固定架术后的MAD、FTA、MPTA、LDTA、JLCA、LLD差异有统计学意义(P＜0.05)。结论外固定架与内固定矫正胫骨畸形具有相同临床疗效，但外固定架矫正畸形具有切口较小、创伤小、精确性高、可术后多次调整等优点，对于合并LLD者尤为适宜，值得临床推广应用。

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	许兆辰
	陈永程
	张保刚
	张萌
	乔锋

关键词 ：胫骨畸形, 外固定架, 内固定, 截骨矫形

Abstract：Objective To investigate the clinical efficacy of six-axis external fixator based on CT data and internal fixation in the correction of tibial deformity.Methods The clinical data of 60 patients who underwent tibial deformity correction from January 2019 to January 2023 were retrospectively analyzed.According to the choice of operation，they were divided into internal fixation group(30 cases) and external fixation group(30 cases).There were 9 males and 21 females in the internal fixation group，with an average age of (32.83±7.73) years old.There were 15 males and 15 females in the external fixation group，with an average age of (31.17±8.43) years old.The surgical conditions，osteotomy healing time，postoperative complications and postoperative follow-up imaging measurement indicators were compared between the two groups.Results All patients were followed up for 6~15 months，with an average of (6.97±1.69) months.Compared with the internal fixation group，the incision length of the external fixation group was shorter (P＜0.05)，and the healing time of the osteotomy was longer (P＜0.05).There was no significant difference between the two groups in operation time，blood loss，ambulation time，hospitalization time and complications (P＞0.05).There was no significant difference in mechanical axis deviation(MAD)，femoro tibial angle(FTA)，medial proximal tibial angle(MPTA)，lateral distal tibial angle(LDTA)，lateral distal femoral angle(LDFA)，joint line convergence angle(JLCA)，and leg length discrepancy(LLD) between the two groups before operation(P＞0.05).There was no significant difference in FTA，MPTA，LDTA，LDFA and JLCA between the two groups after operation (P＞0.05).The MAD and LLD of the external fixation group were smaller than those of the internal fixation group，and the difference was statistically significant (P＜0.05).Comparison with preoperative，there were statistically significant differences in MAD，FTA，MPTA，LDTA and JLCA after operation in the internal fixation group (P＜0.05)，and there were statistically significant differences in MAD，FTA，MPTA，LDTA，JLCA and LLD after operation in the external fixation group (P＜0.05).Conclusion External fixator and internal fixation have the same clinical efficacy in the correction of tibial deformity，but external fixator has the advantages of small incision，small trauma，high accuracy and multiple adjustment after operation.It is especially suitable for patients with LLD and is worthy of clinical application.

Key words： tibial deformity external fixator internal fixation osteotomy

基金资助:陕西省重点研发计划(2023-YBSF-675)

通讯作者: 乔锋

作者简介: 许兆辰(1991－ )，男，医师，西安市红会医院中西医结合骨科，849635550@qq.com

引用本文:

许兆辰，陈永程，张保刚，张萌，乔锋. 基于CT数据六轴外固定架与内固定在矫正胫骨畸形中的应用[J]. 实用骨科杂志, 2024, 30(4): 311-.
Xu Zhaochen，Chen Yongcheng，Zhang Baogang，Zhang Meng，Qiao Feng. Comparison of the Application of Six-Axis External Fixator Based on CT Data and Internal Fixation in the Correction of Tibial Deformity. sygkzz, 2024, 30(4): 311-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I4/311

［1］Sculco PK，Kahlenberg CA，Fragomen AT，et al.Management of extra-articular deformity in the setting of total knee arthroplasty［J］.J Am Acad Orthop Surge，2019，27(18)：e819-e830.
［2］Popkov A，Aranovich A，Popkov D.Results of deformity correction in children with X-linked hereditary hypophosphatemic rickets by external fixation or combined technique［J］.Int Orthop，2015，39(12)：2423-2431.
［3］Eralp L，Kocaoglu M，Toker B，et al.Comparison of fixator-assisted nailing versus circular external fixator for bone realignment of lower extremity angular deformities in rickets disease［J］.Arch Orthop Trauma Surg，2011，131(5)：581-589.
［4］Li G，Tang X，Li J，et al.Error identification and compensation regarding the kinematic parameter of the MD-PEF for tibial deformity correction［J］.Comput Biol Med，2023(158)：106813.
［5］Gigi R，Mor J，Lidor I，et al.Auto strut：A novel smart robotic system for external fixation device for bone deformity correction，a preliminary experience［J］.J Child Orthop，2021，15(2)：130-136.
［6］Matsushita M，Kitoh H，Mishima K，et al.A retrospective comparative study of corrective osteotomy for tibial deformities with the multiaxial correction fixator and the circular fixator［J］.J Clin OrthopTrauma，2020，11(Suppl 4)：S621-S625.
［7］Song H，Raju SV，Kumar S，et al.Deformity correction by external fixation and/or intramedullary nailing in hypophosphatemic rickets［J］.Acta Orthop，2009，77(2)：307-314.
［8］Liu Y，Cai F，Liu K，et al.Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator［J］.BMC Musculoskeletal Disorders，2021，22(1)：803.
［9］Blondel B，Launay F，Glard Y，et al.Limb lengthening and deformity correction in children using hexapodal external fixation：Preliminary results for 36 cases［J］.Orthop Traumatol Surg Res，2009，95(6)：425-430.
［10］Bakircioglu S，Caglar O，Yilmaz G.Multiplanar correction of proximal tibial recurvatum deformity with tibial osteotomy and computer assisted fixator［J］.Knee，2021(32)：159-165.
［11］刘曙光，乔锋，黄小强，等.角度可调式截骨导向器在股骨远端闭合截骨中的临床应用［J］.中华外科杂志，2020，58(11)：876-881.
［12］Liu S，Yu D，Li H，et al.Combination of external fixation using digital six-axis fixator and internal fixation to treat severe complex knee deformity［J］.J Orthopa Surg Res，2023，18(1)：65.
［13］Goodier WD，Calder PR.External fixation for the correction of adult post-traumatic deformities［J］.Injury，2019，50(suppl 1)：S36-S44.
［14］Hughes A，Parry M，Heidari N，et al.Computer Hexapod-Assisted Orthopaedic Surgery for the Correction of Tibial Deformities［J］.J Orthop Trauma，2016，30(7)：e256-e261.
［15］杨胜松，黄雷，赵文志，等.单边轨道式外固定支架辅助髓内钉治疗胫骨畸形［J］.中华骨科杂志，2019，39(18)：1117-1124.
［16］Yilmaz G，Bakircioglu S.Correction of distal femoral valgus deformities with fixator-assisted plating：How accurate is the correction?［J］.Acta Orthop Traumatol Turc，2019，53(2)：100-105.
［17］Jaarsma RL，Pakvis DF，Verdonschot N，et al.Rotational malalignment after intramedullary nailing of femoral fractures［J］.J Orthop Trauma，2004，18(7)：403-409.
［18］Ashfaq K，Fragomen A，Nguyen J，et al.Correction of proximal tibia varus with external fixation［J］.J Knee Surg，2012，25(5)：375-384.
［19］Mccarthy JJ，Mark AK，Davidson RS.Treatment of angular deformities of the tibia in children：Acute versus gradual correction［J］.J Surg Orthop Adv，2007，16(3)：118-122.
［20］Liu Y，Liu J，Yushan M，et al.Management of high-energy tibial shaft fractures using the hexapod circular external fixator［J］.BMC Surg，2021，21(1)：95.
［21］Frihagen F，Madsen JE，Sundfeldt M，et al.Taylor spatial frame or reamed intramedullary nailing for closed fractures of the tibial shaft：A randomized controlled trial［J］.J Orthop Trauma，2020，34(11)：612-619.
［22］Paley.矫形外科原则［M］.陈坚，译.北京：中国医药科技出版社，2006：411-433.
［23］Borici N，Ezeokoli EU，Ruci J，et al.Management of femur and tibial leg length discrepancies with a unilateral external fixator is still viable when more advanced techniques and hardware are unavailable or cost-prohibitive［J］.Cureus，2022，14(1)：E21010.
［24］Bliven EK，Greinwald M，Hackl S，et al.External 〖CM(22〗fixation of the lower extremities：Biomechanical〖CM)〗perspective and recent innovations［J］.Injury，2019，50(suppl 1)：S10-S17.
［25］Park YE，Song SH，Kwon HN，et al.Gradual correction of idiopathic genu varum deformity using the Ilizarov technique［J］.Knee Surg Sports Traumatol Arthrosc，2013，21(7)：1523-1529.
［26］钟豪良，路玉峰，乔锋，等.基于CT数据六轴外固定架在成人Blount病治疗中的应用［J］.实用骨科杂志，2021，27(5)：437-440.
［27］Chalopin A，Geffroy L，Pesenti S，et al.Correction of axial deformity during lengthening in fibular hypoplasia：Hexapodal versus monorail external fixation［J］.Orthop Traumatol Surg Res，2017，103(5)：755-759.
［28］Saw A，Phang ZH，Alrasheed MK，et al.Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults［J］.J Orthop Surg (Hong Kong)，2019，27(3)：615534275.
［29］Sachs O，Katzman A，Abu-Johar E，et al.Treatment of adolescent blount disease using taylor spatial frame with and without fibular osteotomy：Is there any difference?［J］.J Pediatr Orthop，2015，35(5)：501-506.