Ilizarov技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形  

Ilizarov technique combined with limited surgery for correction of spastic clubfoot in adolescents with cerebral palsy

作　　者：高纯志 吴晗[1] 肖鹏[1] 吴学建[1] 

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中国修复重建外科杂志》2018年第2期182-186,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用Ilizarov技术结合软组织松解肌力平衡术治疗青少年脑瘫痉挛性马蹄内翻足畸形的疗效。方法回顾性分析2011年6月—2016年9月收治并符合选择标准的29例(33足)青少年脑瘫痉挛性马蹄内翻足畸形患者临床资料。其中,男17例(20足),女12例(13足);年龄13~28岁,平均17.6岁。依据Diméglio分级:Ⅱ级19足,Ⅲ级14足。给予软组织松解肌力平衡术,同时用Ilizarov技术纠正内翻畸形;术后5~7 d开始调节外固定架至达满意足踝形态为止,拆除外固定架后佩戴矫形支具,并逐渐减少佩戴时间至完全弃用。结果 29例(33足)均获随访,随访时间12~22个月,平均18个月。拆除外固定架后均恢复跖行足,无钉道感染及神经血管损伤发生。1足于拆除外固定架后6个月畸形轻度复发,经对症处理后,患者步态恢复正常。其余32足随访期内均无畸形复发。末次随访时,根据国际马蹄足畸形研究学组(ICFSG)评分为(5.21±3.91)分,与术前(36.73±4.80)分比较,差异有统计学意义(t=47.227,P=0.000);获优27足、良3足、中3足,优良率达90.91%。患者自评疗效27足非常满意,6足满意。结论 Ilizarov技术治疗马蹄内翻足疗效确切,同时根据症状体征结合适当软组织手术可有效治疗青少年脑瘫痉挛性马蹄内翻足畸形。Objective To evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy. Methods A retrospective analysis of clinical data of 29 cases （33 feet） of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male （20 feet） and 12 were female （13 feet） with an age range from 13 to 28 years （mean, 17.6 years）. According to Dim6glio classification, 19 feet were rated as grade Ⅱ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external FLxator, and the wearing time gradually reduced to completely abandon the brace. Results All 29 patients （33 feet） were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group （ICFSG） score （5.21±3.91） was significantly lower than the preoperative score （36.73±4.80）, and the difference was significant （t=-47.227, P=-0.000）. The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness. Conclusion Ilizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with app

关 键 词：ILIZAROV技术 马蹄内翻足 脑瘫 青少年 

分 类 号：R726.8[医药卫生—儿科]