Ilizarov 外固定架联合跟骨截骨矫正痉挛性马蹄内翻足

Treatmen of clubfoot varus with Ilizarov external fixation and osteotomy of calcaneus

摘要:

探究 Ilizarov 外固定架和跟骨外侧柱短缩截骨矫正痉挛性脑瘫马蹄内翻足的临床疗效。方法选取该院骨科 2011 年 1 月 -2016 年 6 月收治的痉挛性脑瘫马蹄内翻足合并跟骨内翻畸形患儿 30 例，共 42足。住院期间均行手术治疗，术中采用跟骨外侧柱矩形截骨，跟腱延长，胫前肌外移，伊式架外固定手术，充分解决跟骨内翻畸形。术后随访观察患儿患足形态特征、功能状况及 X 线情况，应用国际马蹄足畸形研究学组（ICFSG）评分系统评分，回顾性分析患者的临床资料。结果 所有患者的顺利完成手术，平均手术时间（178.6±42.1）min，平均术中出血量（74.8±26.3）ml，术后平均住院时间（9.7±1.5）d，所有患者均获随访，平均随访时间（23.5±3.0）个月。至末次随访未见严重感染、截骨不愈合或延迟愈合等手术相关并发症,外形及行走功能明显改善，患足背伸肌力良好。与治疗前相比，患者拆除伊氏架外固定和末次随访时患足背伸角度增加，ICFSG 评分降低，差异均有统计学意义（ <0.05），末次随访时改善更加显著。结论 跟骨外侧柱矩形短缩截骨术可有效减少足外侧柱长度，使中足、前足内翻得到矫正，减轻跟骨内翻，增大了距下复合体的间隙，使距骨下沉，改善高弓足，达到弹性生理负重状态从而改善患儿的行走步态，是治疗痉挛性脑瘫马蹄内翻足临床效果满 意的手术方式。

Abstract:

To explore the effect of treatment of clubfoot varus with Ilizarov external fixation and calcaneal lateral column shortening osteotomy in patients with spastic cerebral palsy.Methods Thirty patients of spastic cerebral palsy with clubfoot(42 feet)treated in ourhospital from January 2011 to June 2016 were selected.They were given rectangular osteotomy of the lateral column of calcaneus,Achilles tendon lengthening,anterior tibialis transferand Ilizarov external fixation.After operation,the patients were followed up forob servation of the morphological characteristics,the function ofankle jointand International Clubfoot Study Group (ICFSG)scores.Results Allpatients had successful surgeries.The operation time was(178.6 ± 42.1)min.The blood transfusion volumewas(74.8 ± 26.3)ml.The postoperative hospital stay was(9.7 ± 1.5)d.The follow-uptimewas(23.5 ± 3.0)m.There was no serious postoperative complication.The footdor siflexion angles atremoval of the Ilizarov external fixation and the end of the follow-up were greaterthan that before operation( p< 0.05),but the ICFSG scores were lowerthan those before operation ( p< 0.05).Conclusions Rectangu larosteotomy of lateral column of calcaneusis brilliantin thetreatment of clubfootin patients with spastic cerebral palsy.