特发性马蹄内翻足微创软组织松解术后足底力学指标评价  

Evaluations of plantar mechanics after mini-invasive soft tissue release of idiopathic clubfoot

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] 翁刘其[1] 周海[1] 郑超[1] Liu Hang;Li Ming;Liu Xing;Luo Cong;Cao Yujiang;Liu Chuankang;Qu Xiangyang;Weng Liuqi;Zhou Hai;Zheng Chao(Orthopedic Center,Affiliated Children's Hospital,Chongqing Medical University,Ministry of Education Key Laboratory of Child Development&Disorders,National Clinical Research Center for Child Health&Disorders,China International Science&Technology Cooperation Base of Child Development&Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing,400014,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,国家儿童健康与疾病临床医学研究中心,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,重庆市400014

出　　处：《临床小儿外科杂志》2020年第9期775-778,共4页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科建设项目(编号:国卫办医函[2013]544)。

摘　　要：目的采用足底形态扫描及静态足压评价DimeglioⅣ型特发性马蹄内翻足经微创多平面软组织松解术治疗后的短期疗效。方法选取2016年1月至2018年6月于重庆医科大学附属儿童医院首诊并接受微创多平面软组织松解术治疗的DimeglioⅣ型特发性马蹄内翻足病例共17例(25足)为病例组,其中男12例(18足),女5例(7足),手术年龄为1个月23天至6个月21天,评价年龄2岁5个月至2岁11个月;同期选取同年龄段健康儿童10人(20足)为对照组。采用Dimeglio评分、X线摄影、足底形态扫描分析、静态足压分析评价患足恢复情况。结果DimeglioⅣ型特发性马蹄内翻足经微创多平面软组织松解术系列治疗后Dimeglio评分0~2分;患足外观恢复满意。X线片显示:术前正位跟距角(14.90±3.20)°,术后正位跟距角(33.51±7.52)°;术前侧位跟距角(22.65±6.10)°,术后侧位跟距角(33.08±4.12)°;差异均具有统计学意义(P<0.05)。患儿足弓指数(0.35±0.02),正常对照组儿童的足弓指数(0.35±0.01),差异无统计学意义(P>0.05);患儿双踝角(82.03±6.20)°,正常对照组双踝角(85.27±3.49)°,差异无统计学意义(P>0.05)。术后双侧马蹄内翻足双足压力分布百分比[(52.75±2.32)%vs.(47.25±2.32)%,P<0.05]以及术后单侧马蹄内翻足双足压力分布百分比[(60.33±4.54)%vs.(39.70±4.55)%,P<0.05],差异均有统计学意义。结论微创多平面软组织松解术治疗DimeglioⅣ型特发性马蹄内翻足畸形矫正满意,短期疗效肯定。足底力学评价结果可以作为马蹄内翻足术后针对性治疗策略的重要参考指标。Objective To evaluate the short-term efficacies of mini-invasive multiplanar soft tissue release for Dimeglio gradeⅣidiopathic clubfoot by plantar scan and static plantar pressure.Methods From January 2016 to June 2018,17 cases(25 feet)of Dimeglio gradeⅣidiopathic clubfeet underwent mini-invasive multiplanar soft tissue releasing.There were 12 boys(18 feet)and 5 girls(7 feet).The operative age range was from 53 to 201 days and the evaluation age 29 to 35 months.The recovery status of clubfeet was evaluated by Dimeglio score,radiography,plantar scan and static plantar pressure analysis.Results Dimeglio scores were 0-2 points after serial casting and mini-invasive multiplanar soft tissue releasing and the appearance of affected feet was satisfactory.Radiography indicated that preoperative and postoperative anteroposterior talocalcaneal angle was 14.90±3.20°,33.51±7.52°respectively and lateral talocalcaneal angle 22.65±6.10°,33.08±4.12°.The differences were statistically significant(P<0.05).The arch indices were 0.35±0.02 and 0.35±0.01.There was no significant inter-group difference(P>0.05).The bimalleolar angles were 82.03±6.20°and 85.27±3.49°.There was no significant difference(P>0.05).The distribution percentage of pressures in bilateral talipes equinovarus was[(52.75±2.32)%:(47.25±2.32)%,P<0.05]and that of unilateral talipes equinovarus[(60.33±4.54)%:(39.70±4.55)%,P<0.05].Conclusion Mini-invasive multiplanar soft tissue release is efficacious for idiopathic clubfoot of Dimeglio gradeⅣ.The outcomes of plantar mechanic evaluations may be used as an important reference for targeted maintenance therapeutics of clubfoot.

关 键 词：马蹄足畸形/外科学 外科手术 微创性 治疗结果 力学 

分 类 号：R726.8[医药卫生—儿科] R681.8[医药卫生—临床医学]