Ilizarov技术治疗大龄儿童僵硬型先天性马蹄内翻足  

Treatment of rigid congenital clubfoot with Ilizarov technique in older children

作　　者：刘行[1] 李明[1] 刘星[1] 罗聪[1] 曹豫江[1] 刘传康[1] 瞿向阳[1] LIU Hang;LI Ming;LIU Xing;LUO Cong;CAO Yujiang;LIU Chuankang;QU Xiangyang(Orthopedic Center of Children＇s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing,400014,P.R.China)

机构地区：[1]重庆医科大学附属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：《中国修复重建外科杂志》2018年第10期1267-1270,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544)~~

摘　　要：目的探讨Ilizarov技术治疗大龄儿童僵硬型先天性马蹄内翻足的效果。方法回顾性分析2005年9月—2015年9月收治的55例(69足)僵硬型先天性马蹄内翻足(DiméglioⅣ型)患儿临床资料。男33例,女22例;年龄6~14岁,平均11岁。单侧41例,双侧14例。术前根据国际马蹄足畸形研究学组(ICFSG)评价标准,一般24足,差45足。采用Ilizarov外固定架结合有限软组织松解治疗,其中21足结合个体化V形截骨治疗。结果患儿均获随访,随访时间2~10年,平均4.2年。术后切口愈合良好。5例发生针道感染,经局部换药治愈。根据ICFSG评价标准评价疗效,获优39足、良21足、一般9足,优良率87.0%。X线片复查示,随访期间无距骨、舟骨、楔骨、跖骨、跟骨、骰骨血供障碍及坏死,无骨髓炎发生。结论对于大龄儿童僵硬型先天性马蹄内翻足,采用Ilizarov外固定架技术结合有限软组织松解或V形截骨矫正,安全且矫形效果显著。Objective To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods A clinical data of 55 patients（69 feet） with rigid congenital clubfoot（Diméglio grade Ⅳ） between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years（range, 6-14 years）. There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group（ICFSG） score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results All patients were followed up 2-10 years（ mean, 4.2 years）. The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion Ilizarov technique combined with limited soft tissue release or Vshaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.

关 键 词：儿童 僵硬型先天性马蹄内翻足 ILIZAROV技术 软组织松解 

分 类 号：R726.8[医药卫生—儿科]