Ilizarov技术结合有限手术治疗伴有皮肤溃疡的马蹄内翻足  

Treatment of equinovarus accompanied with ulcer using Ilizarov technology and limited operation

作　　者：焦绍锋 秦泗河 郭保逢[2] 王振军 吴鸿飞[2] 潘奇 

机构地区：[1]国家康复辅具研究中心附属康复医院,北京100000 [2]北京市垂杨柳医院,北京100000

出　　处：《中国骨伤》2015年第2期145-149,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨采用Ilizarov技术结合有限手术治疗伴有负重区溃疡的神经营养不良性马蹄内翻足畸形的手术方法及临床疗效。方法：2004年7月至2011年12月收治21例伴有负重区溃疡的神经障碍性马蹄内翻足畸形患者,其中男14例,女7例;年龄8-32岁,平均21.3岁;脊柱裂致马蹄内翻足畸形19例,腰骶段脊髓损伤致马蹄内翻足畸形2例;左侧9例,右侧12例;第5跖骨头外下区溃疡6例,第5跖骨基底部溃疡5例,跟骰关节外侧溃疡2例,距下关节外侧溃疡8例。采用跖内侧松解,跟腱延长,三关节有限截骨,其中皮肤溃疡位于距下关节外侧者,术中同时切除溃疡皮肤及软组织,Ⅰ期缝合皮肤切口,术中部分矫正马蹄内翻足畸形后穿针安装Ilizarov足踝部外固定牵伸器。术后负重区仍遗留皮肤溃疡者,溃疡局部使用中成药生肌膏进行换药,每日1次,直至创面愈合。术后7 d开始调节Ilizarov牵伸器矫正残余马蹄内翻足畸形,直至马蹄内翻畸形矫正满意为止,在牵伸矫形过程中患足部分负重行走。结果：21例均获随访,时间6-52个月,平均28个月。所有溃疡愈合,溃疡愈合时间术后14-36 d,平均26 d,随访时溃疡均无复发;18足畸形矫正满意,完全恢复跖行足,3足于术后1年复查出现畸形轻度复发;15例踝关节活动度不同程度受限,6例踝关节完全僵直。AOFAS综合评分由术前34.0±7.2提高到术后86.0±8.5;优8足,良10足,中3足。结论：采用Ilizarov技术结合有限矫形手术治疗伴有负重区神经营养障碍性溃疡的马蹄内翻足畸形,辅助外用中药生肌膏治疗,可以达到Ⅰ期畸形矫形及治愈溃疡的满意效果,手术方法简单,医疗过程安全,能规避严重并发症的发生。Objective：To explore the surgical method and clinical curative effect of Ilizarov technique combined with limited surgical treatment for neurotrophic malnutrition equinovarus accompanied with weight bearing area ulcer. Methods： From July 2004 to December 2011,21 cases of neurological disorders equinovarus with skin ulcer in weight bearing area were treated including 14 males and 7 females with an average age of 21.3 years old ranging from 8 to 32 years. Among them,19 cases with talipes equinovarus were on account of spina bifid and 2 cases on account of spinal cord injury of lumbar sacral segment.Nine cases were on the left foot and 12 cases were right foot. The ulcer area in out below side of the fifth metatarsal bone was in6 cases,in basement of the fifth metatarsal bone in 5 cases,in lateral of calcaneocuboid joint 2 cases,and in lateral of subtalar joint in 8 cases. Surgical procedure included plantar medial release technique,tendo chilles lengthenning,and three joint partial osteotomy. During operation,the skin and soft tissue of ulcer were resected and the incision was sutured when the ulcer was in the lateral of subtalar joint,and ankle Ilizarov external fixation for extension was installed after correcting talipes equinovarus partially. For the legacy skin ulcer in weight bearing area,the Sheng ji cream（生肌膏） was used after operation for one time per day until the wound healed. Adjusting Ilizarov external fixation for correcting residual deformity until it is satisfaction.During this process weight bearing walking was keeping. Results：All cases were followed up from 6 to 52 months with an average of 28 months. All ulcers were healing and no recurrence. The ulcer healing time was 14 to 36 days postoperative（26 days in average）. Eighteen deformity feet were corrected satisfactorily,and recovered fully plantar foot,3 feet appeared mild deformity after 1 year. Ankle joint activity appeared limited in 15 cases and got completely rigidity in 6 cases. The AOFAS increased from preoperative 34.0

关 键 词：伊利扎罗夫技术 脊柱裂 脊髓损伤 马蹄足畸形 溃疡 

分 类 号：R726.826[医药卫生—儿科]