摘要
目的探讨用Ilizarov张力-应力法则结合三关节有限截骨术矫正成年人重度马蹄内翻足畸形的疗效。方法1996年1月～2003年2月,应用Ilizarov张力-应力法则结合三关节有限截骨一期矫正成年人重度马蹄内翻足患者12例13个足,男9例,女3例;年龄20～36岁,平均26岁;左足4例,右足7例,双足1例。病因先天性马蹄内翻足3例,小儿麻痹后遗足畸形6例,外伤1例,脑性瘫痪后遗足畸形1例,小腿海绵状血管瘤施行放射治疗后遗马蹄内翻足畸形1例。根据病情,术前组装Ilizarov踝足关节牵伸器,术中先实施足的后内侧软组织有限松解和三关节切骨术,依照Ilizarov的穿针固定原则,安装具有三维矫形功能的踝足关节牵伸器。术后7d旋转螺纹牵伸杆,逐渐矫正足内翻、内收和前足下垂畸形,在牵伸矫形过程中患足可负重行走。结果12例患者均获得随访,随访时间7个月～4年,平均15个月,畸形未复发,足持重行走功能良好。术后平均牵伸71d。10例11个足达到0°位全足持重,2例保留15°～20°足下垂角(因合并下肢短缩)。术后无一例发生切口和针道感染、皮瓣坏死、血管神经损伤、骨不愈合等并发症。结论Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足是安全、微创、有效的方法。
Objective To explore the application of the Ilizarov's principle on tension-stress in correction of adult severe talipes equinovarus. Methods From January 1996 to February 2003, 12 patients (13 feet) were corrected with this method, which involved 9 males and 3 females, whose average age was 26 years old (ranged from 20-36 years). The left foot was afflicted in 4 patients, and the right foot in 7, both side in 1. Among these patients, 3 were congenital, 6 were caused by the poliomyelitis, 1 by trauma, 1 by complication from encephalitic paralysis and 1 by radiotherapy for the cavernous hemangioma of the leg. The Ilizarov distraction apparatus of the ankle and foot joint were equipped in terms of the diseases preoperatively. During the operation, the release of the postero-medial soft tissue and the limited osteotomy of triple joints of the clubfoot were performed. According to the principles of Ilizarov, the wires were inserted and the fixator installed, the distraction devices of the ankle and foot joint which had corrective function in three-dimensional directions were applied to the tibia and foot, the telescopic rods on the apparatus were rotated one week after the operation. The deformity of talipes equinovarus, internal rotation and the drooping of the forefoot were gradually corrected, and the patients could bear weight and walked on the deformity foot during the course of distractive correction. Results All the 12 patients were available at follow-up with a mean duration of 15 months (ranged from 7 months to 4 years). There was no recurrence of the deformity and the feet function was good while walking on full weight-bearing. The mean duration of traction was 71 days. 10 patients (11 feet) could gain 0° in full weight-bearing, 2 patients preserved the drooping feet deformity at 15°-20° (because of shortness in the lower extremety). None of the complications occurred postoperatively, such as infection in the incision or pin tract, necrosis of the flap, neurovascular injury and nonunion. Conclusion Utilizing Ilizarov's principle on tension-stress to correct severe adult talipes equinovarus is a safe, minimally invasive and effective method.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第6期338-341,共4页
Chinese Journal of Orthopaedics
