摘要
的探讨Ilizarov技术矫治复杂僵硬性马蹄内翻足的临床疗效。方法回顾性分析2005年7月至2011年7月28例（41足）僵硬性马蹄内翻足患者的病例，男18例（26足），女10例（15足）；年龄3--45岁，平均15-3岁；左足8例，右足7例，双足13例。根据Dim6glio畸形分级：Ⅲ级31足，Ⅳ级10足。23足采用有限软组织松解、18足配合有限截骨后均安装Ilizarov外固定牵伸器。比较术前及末次随访时踝关节跖屈及背伸角度、踝关节活动度、正侧位X线片上患足距跟角的变化。结果28例患者均获得随访，随访时间5-38个月，平均25个月。术后外固定支架佩戴2-14个月，平均5．1个月；去除支架后所有患足均获跖行步态，外形接近正常，无足短缩。足背伸角度：术前-45．0°±12．0°，末次随访9．5°±5．5°；跖屈角度：术前67．0°±14．0°，末次随访45．5°±7．8°；正、侧位x线片距跟角：术前分别为6．5°±4．5°和5．5°±11．0°，末次随访分别为22．5°±5．5°和40．6°±8．5°。1足术后发生急性血管痉挛性缺血，予减缓牵伸速度后缓解；5足发生针道感染，予更换针道及换药后感染控制。去支架后3个月，1足出现畸形复发，予二次矫形；3足畸形残留，5足趾屈曲挛缩，均给予二次软组织矫形术，未再复发。结论Ilizarov技术矫治复杂僵硬性马蹄内翻足疗效确切，能最大程度保留足外形和功能，避免足短缩，不影响足发育。
Objective To evaluate the clinical results of the Ilizarov technique for the treatment of the complex rigid talipes equinovarus deformities. Methods From July 2005 to July 2011, 28 patients （41 feet） with rigid talipes equinovarus deformities which had been corrected with the Ilizarov technique were retrospectively analyzed, including 18 males （26 feet） and 10 females （15 feet） with an average age of 15.3 years. According to the classification system proposed by Dim6glio, 31 feet were categorized as gradeⅢ, and 10 as grade IV. We performed corrections with a soft tissue release in 23 feet, and with a limited osteotomy in 18, and then a Ilizarov external fixator was applied. Anteroposterior and lateral X-rays were taken to compare the pre and postoperative data in terms of the angle of plantarflexion and dorsiflexion, the range of motion of the ankle joint, radiological measurements of the talocalcaneal angle. Results All the 28 patients achieved an outpatient follow-up, with an average of 25 months. All patients achieved a plantigrade foot with an almost normal appearance as the fixator was removed after applied for an average of 5.1 months （range, 2- 14）. At the preoperative and final follow-up respectively, the angle of dorsiflexion of the foot was -45.0°± 12.0° and 9.5°±5.5°, the angle of plantarflexion was 67.0°±14.0° and 45.50°±7.8°, talocaleaneal angle was 6.50°±4.5° and 22.50°±5.5° in anteroposterior radiograph and 5.5°±11.0° and 40.6°±8.5° in lateral radiograph. Spastic ischemia occurred in one foot and relieved by a slower distraction rate. Wire-hole infections occurred in 5 feet and treated by dressing changs, wire tract altering and antibiotic therapy, finally the infections were controlled. Deformity relapsed in one foot three months after the device was removed, then corrected with an additional fixator application and has not recurred till the final follow-up. Toe contracture and residual defor- mity occurred in 5 feet and 3 feet, respectively. Conclusion The Ilizarov technique is an effective method for correction of complex rigid talipes equinovarus deformities, with which the appearance and function of the foot could be kept as much as possible, and without impact on food development.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第3期222-228,共7页
Chinese Journal of Orthopaedics
