摘要
目的 探讨Ilizarov技术结合跗骨v形截骨治疗创伤性马蹄内翻足的临床疗效。方法2011年8月~2014年8月收治14例创伤性马蹄内翻足患者。男10例,女4例;年龄13~61岁,平均31岁。胫骨、踝关节开放性骨折11例,踝关节闭合性骨折3例。手术距受伤时间7~78个月,平均36个月。踝关节固定于跖屈位44~89°,平均57°。足软组织微创松解和跗骨v形截骨后,将带有弹性牵伸杆的Ilizarov外固定支架安装在肢体设定位置并穿针固定;术后通过旋转螺母矫正马蹄内翻畸形,5~12周恢复踝关节中立位后继续维持固定8~12周,然后去除外固定支架佩戴支具8~12周,患足逐渐增加负重行走。结果术后9例针道出现轻度感染,对症处理后感染消失。患者均获随访,随访时间10~36个月,平均15个月。治疗结束后踝关节外形正常,X线片检查踝穴关系正常。其中9例踝关节背伸达10°,恢复正常行走功能;4例背伸5。,但不影响正常行走;1例不能背伸,影响上下楼梯。1例矫正过程中出现疼痛,耐受性较差,给予延缓牵引,治疗结束去除外固定后出现反弹,经积极康复训练恢复正常。末次随访时根据国际马蹄足畸形研究学组（ICFSG）评分标准：优9例,良4例。可1例,优良率92.9%。结论Ilizarov技术结合跗骨v形截骨创伤小,固定可靠,畸形矫正效果确切,踝关节功能恢复良好,是治疗创伤性马蹄内翻足的有效方法。
Objective To discuss the effectiveness of Ilizarov technology combined with tarsal V-shape osteotomy for the treatment of traumatic clubfoot. Methods Between August 2011 and August 2014, 14 patients with traumatic clubfoot were treated. There were 10 males and 4 females, aged 13 to 61 years （mean, 31 years）. Of 14 cases, 11 had open fractures of the tibia and ankle, and 3 had closed fracture of the ankle joint. The interval from trauma to operation was 7-78 months （mean, 36 months）. The plantar flexion of the ankle was 44-89° （mean, 57°）. After invasive foot soft tissue release and tarsal V-shape osteotomy, the Ilizarov external fixator with elastic stretching rod was used. At 5-12 weeks after operation, the neutral position of the ankle joint was restored. Then the neutral position of the ankle joint was maintained for 8 to 12 weeks. After removal of external fixator, protective walking brace was used for 8 to 12 weeks. Results Infection occurred in 9 cases, and was cured after symptomatic treatment. The patients were followed up 10-36 months （mean, 15 months）. After treatment, 14 patients had normal appearance of the ankle joint, and X-ray films showed normal structure of the ankle. The ankle dorsal extension was 10° in 9 patients, who had normal walking function; it was 5° in 4 patients, who could walk; in 1 case of neutral position, the foot had no function of up and down stairs. One case had pain during correction because of poor tolerance, and delay traction was given, the function was recovered to normal after active rehabilitation training. According to the International Clubfoot Study Group （ICFSG） score standard, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 92.9% at last follow-up. Conclusion Ilizarov external fixation combined with V-shape osteotomy is effective for the treatment of traumatic clubfoot, with the advantages of less trauma, reliable fixation, satisfactory correction of the deformity, and good function recovery of the ankle.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第12期1474-1477,共4页
Chinese Journal of Reparative and Reconstructive Surgery
