Carroll手术治疗先天性马蹄足术后复发的相关危险因素分析  

Risk factors of relapse of congenital clubfoot after operation with Carroll technique

作　　者：张戈 李明[1] 刘星[1] 罗聪[1] 曹豫江[1] 刘传康[1] 瞿向阳[1] 周海[1] 翁刘其[1] 郑超[1] 卢虹旭[1] 刘行[1] 张圆[1] 宋波 ZHANG Ge;LIMing;LIU Xing;LUO Cong;CAO Yujiang;LIU Chuankang;QU Xiangyang;ZHOU Hai;WENG Liuqi;ZHENG Chao;LU Hongxu;LIU Hang;ZHANG Yuan;SONG Bo(Orthopedic Center,Key Laboratory of Child Development and Disorders of Ministry of Education,China International Science and Technology Cooperation Base of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Children＇s Hospital of Chongqing Medical University,Chongqing,400014,China)

机构地区：[1]重庆医科大学儿童医院骨科中心、儿童发育疾病研究教育部重点实验室、儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室,重庆400014

出　　处：《第三军医大学学报》2018年第14期1311-1315,共5页Journal of Third Military Medical University

基　　金：国家临床重点专科建设项目(国卫办函【2013】544)

摘　　要：目的回顾性分析Carroll手术治疗先天性马蹄足术后复发的相关危险因素。方法选取2006年1月至2015年12月于我院确诊为先天性马蹄内翻足患儿为研究对象。所有患儿均接受Carroll手术治疗,术前Dimeglio分型为Ⅲ型或Ⅳ型,随访2年以上共280例372足,其中复发16例21足。应用卡方检验及二元logistic回归分析,探讨性别,单双侧患病,术前是否石膏矫形,术前Dimeglio分型,手术年龄及术后有效随访指导时间等因素对马蹄足畸形复发的影响。结果经Carroll术式治疗的先天性马蹄内翻足患者,术前Dimeglio分型Ⅳ型(χ2=18.067,P=0.000),术前未接受石膏矫形(χ2=3.902,P=0.048),术后有效随访指导时间短(χ2=23.670,P=0.000)的患儿复发的可能性更大;经二元logistic多因素回归分析结果显示,术前Dimeglio分型Ⅳ型,术后有效随访指导时间是马蹄足复发的独立危险因素。结论 Carroll术式是治疗严重先天性马蹄内翻足患儿的有效方式,术前Dimeglio分型Ⅳ型复发的可能性大,术前进行规范的Ponseti石膏矫形及术后2年以上的有效随访指导有助于降低马蹄足的复发率。Objective To analyze the risk factors of postoperative relapse of congenital clubfoot （CCF） following surgical correction with the Carroll technique. Methods Between January, 2006 and December, 2015, a total of 280 children with established diagnosis of CCF （372 feet, Dimeglio classification Ⅲ or Ⅳ） received surgical intervention with the Carroll technique. The clinical data of the patients were analyzed to assess how the risk factors affect postoperative relapse, including gender, unilateral disease, preoperative correction, preoperative Dimeglio classification, age at operation and compliance with regular follow-up. Results The patients with Dimeglio Ⅳ （Chi square=18.067, P=0.000）, without long-leg plaster cast before surgery （Chi square=3.902, P=0.048）, and incompliant with regular follow-up （Chi square=23.670, P=0.000） were found to have a greater likeliness of experiencing postoperative deformity relapse. Binary logistic analysis showed that Dimeglio classification Ⅳ and incompliance with regular follow-up were independent risk factors of postoperative recurrence. Conclusion Surgical intervention with the Carroll technique is effective for treatment of rigidly CCF. Dimeglio Ⅳ patients are more likely to experience postoperative recurrence of the deformity, which can be reduced by treatment with preoperative casting using the Ponseti method and enhancing the compliance of the patients with regular follow-up for over 2 years.

关 键 词：先天性马蹄内翻足 Carroll手术 术后复发 危险因素 

分 类 号：R181.32[医药卫生—流行病学] R726.19[医药卫生—公共卫生与预防医学]