成人脊柱裂后遗感觉缺失性连枷足的治疗策略  

Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult

作　　者：臧建成 秦泗河 秦绪磊 石磊 吕泽平 ZANG Jiancheng;QIN Sihe;QIN Xulei;SHI Lei;LO Zeping(Department of Orthopaedics,Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids,Beijing,100176,P.R.China;Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability,Beijing,100176,P.R.China;Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs,Beijing,100176,P.R.China)

机构地区：[1]国家康复辅具研究中心附属康复医院矫形外科,北京100176 [2]北京市老年功能障碍康复辅助技术重点实验室,北京100176 [3]民政部康复辅具技术与系统重点实验室,北京100176

出　　处：《中国修复重建外科杂志》2018年第10期1255-1260,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价有限手术结合外固定技术治疗脊柱裂后遗感觉缺失性连枷足的综合疗效,探讨该类型足畸形的治疗策略。方法回顾分析2005年1月—2015年12月应用有限手术结合外固定技术治疗的22例(30足)成人脊柱裂后遗感觉缺失性连枷足患者临床资料。其中男14例,女8例;年龄18～38岁,平均21.5岁。均为踝关节以远感觉缺失。左侧2例2足,右侧2例2足,双侧18例26足。1足伴足底负重区溃疡,3足因既往足骨髓炎致足趾缺失。合并髋关节脱位3例,脊柱侧弯3例,膝关节畸形4例,?趾下垂畸形3例。二便正常控制5例,二便大部分控制10例,充溢性尿失禁6例,膀胱造瘘1例。X线片示椎板闭合不全位于L3～L5 8例,L5、S19例,L3～S3 5例。行踝关节融合12足,跟距关节融合10足;8足踝关节与跟距关节均明显松弛,行踝关节+跟距关节融合术。使用Ilizarov外固定器18足,使用组合式外固定器8足,组合式外固定器联合空心钉内固定3足,Ilizarov外固定器联合空心钉内固定1足。结果 22例患者均获随访,随访时间10～80个月,平均48.5个月。所有足踝畸形术后均得到有效矫正,中后足稳定,恢复跖行足,全足负重,溃疡愈合无复发。发生胫距关节空心螺钉断裂2例,空心钉断裂后骨愈合;未出现手术相关的感染、神经血管损伤等并发症。末次随访时采用秦泗河畸形矫正残缺修复与功能重建术后疗效评价表进行评价,优15足,良9足,可6足,优良率80.0%。结论有限手术结合骨外固定技术治疗成人脊柱裂后遗感觉缺失性连枷足,可获得足踝关节的跖行静力稳定,风险小,并发症少,临床效果良好。Objective To summarize the main methods and comprehensive effects of limited surgery combined with external fixation for the treatment of flail foot with sensory disorder of spina bifida sequela in adult. Method The clinical data of 22 cases（30 feet） of the adult spina bifida sequela who suffered from flail foot with sensory disorder and treated by limited surgery combined with external fixation were retrospectively analysed between January 2005 and December 2015. There were 14 males and 8 females with an age of 8-38 years（mean, 21.5 years）. All 30 feet were distal ankle sensory loss, including 2 cases（2 feet） on the left side, 2 cases（2 feet） on the right side, and 18 cases（26 feet） on both sides. There was 1 foot accompanied by ulcerative plantar ulcers, and 3 feet lost their toes due to foot osteomyelitis in the weight-bearing area. Combined with 3 cases of hip dislocation, 3 cases of scoliosis, 4 cases of knee deformity, and 3 cases of ptosis. There were 5 cases of normal control of urine and stool, 10 cases of partial control of urine and stool, 6 cases of overflow urinary incontinence, and 1 case of cystostomy. According to X-ray film, the lesion of spina bifida was evaluated, the laminar insufficiency was located at L3-L5 in 8 cases, L5, S1 in 9 cases, and L3-S3 in 5 cases. In the patients, 12 feet were performed ankle joint arthrodesis, 10 feet subtalar arthrodesis, and 8 feet tibia-talus-calcaneus arthrodesis. Ilizarov external fixator was used in 18 feet, Hybrid fixator in 8 feet, Hybrid fixator and cannulate screws in 3 feet, and Ilizarov fixator and cannulate screws in 1 foot. Results All 22 patients were followed up 10-80 months（mean, 48.5 months）. All ankle deformities were corrected effectively after operation, the middle and hind feet were stable, the plantar foot was restored, the whole foot was loaded, and the ulcer healed without recurrence. There were 2 cannulate screws ruptured in the subtalar arthrodesis, bone healed after screws break; no complication such as surgica

关 键 词：外固定 ILIZAROV技术 脊柱裂 足踝畸形 连枷足 CHARCOT关节病 

分 类 号：R658.3[医药卫生—外科学]