摘要
目的探讨有限软组织手术联合Ilizarov技术治疗神经损伤后痉挛性马蹄内翻足(SEF)的临床效果。方法纳入37例(43足)脑外伤或脑卒中后SEF患者。根据患者情况行有限软组织手术(胫前肌腱转位术、跟腱延长术、选择性胫神经分支切断术等),随后均行Ilizarov外固定治疗。记录患者术后跖行足恢复和踝阵挛缓解情况,以及术后6个月内并发症和复发发生情况;比较术前及术后6个月患者行走时对辅助器材的使用情况、步态分析时空参数、小腿后群肌的肌张力。结果术后患者均恢复跖行足,踝阵挛较前减少(81.4%比7.0%,P<0.05)。2例(5.4%)患者术后出现钉道感染,1例(2.7%)患者术后3个月出现畸形复发。术后患者辅助器材使用率为29.7%,低于术前的100.0%(P<0.05)。术后患者的步长、步频、步速较术前提高,步行周期较术前缩短,肌张力较术前降低(均P<0.05)。结论有限软组织手术联合Ilizarov技术治疗脑外伤、脑卒中后SEF疗效确切,并发症少,复发率低。
Objective To investigate the clinical efficacy of limited soft tissue surgery combined with Ilizarov technique for treating spastic equinovarus foot(SEF) after nerve injury.Methods Thirty-seven patients(43 feet) with SEF after brain injury or stroke were enrolled.Limited soft tissue surgery(anterior tendon transposition,tendo-achilles lengthening or selective tibial neurotomy,etc.) was performed according to the condition of patients,and then external fixation with Ilizarov technique was conducted in all cases.The postoperative recovery of plantigrade foot and remission of ankle clonus,incidence of complications and recurrence within 6 months after operation were recorded;the auxiliary tools utilization while walking,spatiotemporal parameters of gait analysis and muscular tension of posterior crural muscle group were compared between before operation and 6 months after operation.Results After operation,all patients recovered plantigrade foot,ankle clonus was reduced compared to preoperation(81.4% vs.7.0%,P<0.05).Pin track infection occurred in 2(5.4%) patients,and recurrence of deformity at 3 months after operation in 1(2.7%) patient.The postoperative utilization rate of auxiliary tools was lower than preoperative rate(29.7% vs.100.0%,P<0.05).In comparison with preoperation,the patients obtained improved step length,step frequency and step velocity,shorter gait cycle,and decreased muscular tension after operation(all P<0.05).Conclusion Limited soft tissue surgery combined with Ilizarov technique obtains a definite efficacy for SEF after brain injury or stroke,with less complications and lower recurrence rate.
作者
夏丽伟
韦广源
蒋慧韬
黄菲菲
黄坚汉
XIA Li-wei;WEI Guang-yuan;JIANG Hui-tao;HUANG Fei-fei;HUANG Jian-han(Department of Orthopedics,Jiangbin Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)
出处
《广西医学》
CAS
2019年第20期2583-2585,共3页
Guangxi Medical Journal
基金
广西医药卫生科研课题(Z20180825)
