儿童高弓内翻足：畸形评估与治疗选择  

Cavovarus foot in children： evaluation of deformity and choice of treatment

作　　者：闫桂森[1] 杨征[1] 鲁明[1] 朱振华[1] 张建立[1] 郭源[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华小儿外科杂志》2015年第7期496-500,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的准确评估儿童高弓内翻足畸形并选择针对性治疗方法。方法回顾性分析2008年1月至2013年6月手术治疗的儿童高弓内翻足27例41足的临床资料，年龄7．1～14．5岁，平均11．3岁。手术指征为存在固定畸形引起疼痛、踝关节不稳或穿鞋问题。进行神经学检查、Coleman木块试验，投照负重正侧位、后足轴位以及Coleman木块试验体位X线片来评估足部畸形情况，选择针对性治疗方法，疗效评价采用Wicart分级系统。结果所有病例均为后天性足畸形，80％（33／41）为神经肌肉源性疾患。第一列高弓12足，采用第1跖骨基底背侧闭合楔形截骨；内侧柱高弓16足，采用第1跖骨基底背侧闭合楔形截骨加1-3楔骨跖侧楔形撑开截骨；中足高弓13足，采用舟楔关节背侧闭合楔形截骨；全部41足均进行跖侧松解和骰骨截骨。跟骨固定内翻18足进行跟骨外翻截骨。胫后肌前移21足，腓骨长肌转移至腓骨短肌15足。平均随访28个月，结果优34足，良7足。结论儿童高弓内翻足是一种以足底三脚架异常抬高为主征的后天性足畸形，多合并神经源性疾患。准确评估畸形、选择针对性治疗方法能够获得满意的矫正效果。Objective To precisely assess the deformity of cavovarus foot in children for selecting individualized procedures. Methods A total of 27 surgical patients with 41 cavovarus feet were reviewed. Their average age was 11.3 （7. 1-14. 5） years. The surgical indications included pains, frequent ankle sprains and shoe-wearing problem. And the findings of medical history, neurologic evaluations and symptoms/signs of foot were recorded. The Coleman block test was used to determine the flexibility of hindfoot. Weight-bearing anteroposterior and lateral radiographs and Coleman block view radiographs of feet were taken to assess the component and apex of deformity. And the results were classified by Wicart grading system. Results All foot deformities were acquired. And 80% （33/ 41） of them were associated with neurologic disease. Cavus deformity was located at the first metatarsal in 12 feet undergoing first metatarsal dorsiflexion osteotomy （M1-DFO） at medial column in 16 feet with M1-DFO and opening plantar wedge osteotomy of cuneiform, at midfoot in 13 feet with midfoot osteotomy. The plantar release and cuboid closing wedge osteotomy were performed in all 41 feet. The fixed varus of ealcaneus was found in 18 feet with calcaneal valgus osteotomy. Muscle balance was restored by anterior transfer of posterior tibialis in 21 feet and peroneus tongus to brevis tendon transfer in 15 feet. The average follow-up was 28 （6-51） months. And the results were graded as excellent in 34 feet and fair in 7 feet. Conclusions Pediatric cavovarus foot is an acquired deformity with an abnormal elevation of sole tripod and concurrent neurologie diseases. And satisfactory outcomes may be obtained by careful foot examinations and optimal operations.

关 键 词：畸形足 评估 治疗 

分 类 号：R726.8[医药卫生—儿科]