背景:创伤后踝关节外翻畸形相对罕见。陈旧性创伤后踝关节畸形加上关节周围丰富的瘢痕挛缩组织形成是骨科的一大挑战。传统的一期内固定矫正截骨术总是导致许多棘手的术后并发症,如软组织缺血性坏死,植入物相关感染,和明显的下肢差异。这里,我们描述了一名患有创伤后严重踝关节外翻和前足旋后畸形的患者,并在使用Ilizarov技术和有限截骨术进行多阶段手术后获得了令人满意的临床结果。更令人鼓舞的是,通过我们的治疗方案,成功避免了常规一期手术的任何并发症.
方法:一名24岁的健康男性在创伤后出现90度后足外翻和右脚前足旋后畸形超过10年。复杂的问题是巨大的,血管化不良的瘢痕挛缩组织紧密粘附在外踝和足背的骨骼上。
方法:陈旧性创伤后严重踝关节外翻和前足旋后畸形和足踝关节软组织瘢痕挛缩。
方法:在第一阶段,Ilizarov外固定用于拉伸外踝的瘢痕挛缩组织。在第二阶段,我们对胫骨关节进行了有限的截骨术,并对截骨部位进行了逐步闭合.第三阶段,进行了Chopart关节截骨术和外框缓慢前足内旋。
结果:我们的治疗方案不仅保证了软组织的安全性,同时也避免了感染和明显的下肢不符。在1年的随访中,患者获得美学和功能性右脚。
结论:虽然相对罕见,使用Ilizarov外固定技术结合有限截骨术可以纠正创伤后严重踝关节外翻和前足旋后畸形。有了精心设计的分阶段操作方案,软组织缺血坏死,伤口感染,明显的下肢不一致,可以避免皮瓣移植。
BACKGROUND: Post-traumatic ankle valgus deformities are relatively rare. Old post-traumatic ankle deformity compounded by abundant scar contracture tissue formation around the joint is a big challenge for orthopedics. Conventional one-stage corrective osteotomy with internal fixation always results in many knotty postoperative complications, such as soft tissue avascular necrosis, implant-related infections, and distinct lower limb discrepancy. Here, we describe a patient with old post-traumatic severe ankle valgus and forefoot supination deformities and obtained satisfactory clinical results following multi-stage surgery using the Ilizarov technique and limited osteotomy. Even more encouraging, any complications of conventional one-stage surgery were successfully avoided through our treatment regimen.
METHODS: A 24-year-old healthy man had post-traumatic 90-degree hindfoot valgus and forefoot supination deformities of the right foot for more than 10 years. The complicated issue was the vast, poorly vascularized scar contracture tissues tightly adhered to the bones of the lateral malleolus and dorsum pedis.
METHODS: Old post-traumatic severe ankle valgus and forefoot supination deformities and scar contracture of soft tissues of the foot and ankle joint.
METHODS: In the first stage, Ilizarov external fixation was used to stretch the scar contracture tissue of the lateral malleolus. In the second stage, limited osteotomy of the tibiotalar joint and progressive closure of the osteotomy site were performed. In the third stage, Chopart joint osteotomy and slow forefoot pronation by external frame were performed.
RESULTS: Our treatment regimen not only guaranteed soft tissue safety, but also avoided infection and obvious lower limb discrepancy. At the 1-year follow-up, the patient acquired aesthetic and functional right foot.
CONCLUSIONS: Although relatively rare, old post-traumatic severe ankle valgus and forefoot supination deformities can be corrected using Ilizarov external fixation technology combined with limited osteotomy. With a well-designed staged operation scheme, soft tissue avascular necrosis, infection of the wound, obvious lower limb discrepancy, and flap grafting can be avoided.