摘要
目的探讨影响马蹄内翻足患儿发病的危险因素及Ilizarov疗法对该类患儿的临床疗效。方法回顾性分析2019年6月—2021年4月在杭州市儿童医院确诊的18例马蹄内翻足患儿及其父母亲的临床资料与一般信息(观察组),另选取18例无足部畸形,但合并身体其他部位骨科疾病患儿作为对照组。单因素、多因素分析引发马蹄内翻足患儿发病的独立危险因素;对该18例马蹄内翻足患儿统一采用Ilizarov疗法进行治疗,根据国际马蹄足畸形研究学组(ICFSG)对总体治疗效果进行评估;观察术后并发症发生情况;对该18例患儿进行为期18个月的术后随访,观察截至2022年6月该18例患儿的复发情况。结果多因素分析结果显示,双亲合并HOX基因缺陷、足部血管造影异常、足部骨骼发育异常及足部肌力不平衡是引发马蹄内翻足发生的独立危险因素(P<0.05);相比于治疗前,治疗后的马蹄内翻足患儿ICFSG评分显著降低,而AOFAS评分显著升高,差异均具有统计学意义(均P<0.05);在18例马蹄内翻足患儿中,共有4例(22.22%)患儿出现针道感染现象;截至2022年6月,未见马蹄内翻足复发病例。结论父母基因携带、足部血管异常、骨骼发育异常及肌力不平衡均是可能引起马蹄内翻足发病的独立危险因素,可加强孕期筛查、新生儿体检等项目对儿童进行早期干预,积极的Ilizarov治疗也同样对大龄马蹄内翻足患儿有效。
Objective To investigate the risk factors affecting the morbidity of children with congenital clubfoot and the clinical effect of llizarw therapy on these children.Methods The clinical data and general information of 18 children with congenital clubfoot and their parents diagnosed in Hangzhou Children's Hospital from June 2019 to April 2021 were retrospectively analyzed(observation group).Another 18 children without foot malformations but complicated with orthopedic diseases of other parts of the body were selected as the control group.Univariate and multivariate analysis of the independent risk factors for the incidence of congenital clubfoot;All 18 children were treated with llizarov therapy,and the overall efficacy was evaluated according to the International Congenital Clubfoot Study Group(ICFSG).Postoperative complications were observed.The 18 cases were followed up for 18 months after surgery to observe the recurrence of the 18 cases until June 2022.Results The results of multivariate analysis showed that both parents combined with HOX gene defect,abnormal foot angiography,abnormal foot skeletal development and foot muscle imbalance were independent risk factors for the occurrence of congenital clubfoot(P<0.05);After treatment,ICFSG score was significantly lower and AOFAS score was significantly higher than before treatment(P<0.05);Among the 18 children with clubfoot,4 cases(22.22%)showed needle tract infection.Up to June 2022,no recurrent cases of varus were found.Conclusion Parental gene carrying,foot vascular abnormalities,bone development abnormalities and muscle imbalance are all independent risk factors that may cause the onset of congenital clubfoot.Early intervention can be strengthened for children during pregnancy screening,newborn physical examination and other items.Active Ilizarov treatment is also effective for older children with congenital clubfoot.
作者
王浩然
王汉卿
洪东升
刘子祥
吴鹏
戴荣丹
WANG Hao-Ran;WANG Han-Qing;HONG Dong-Sheng(Department of Orthopedics,Hangzhou Children's Hospital,Hangzhou,Zhejiang 310014,China)
出处
《中国妇幼保健》
CAS
2022年第24期4727-4731,共5页
Maternal and Child Health Care of China
基金
浙江省杭州市医药卫生科技项目(ZD20210003)。
