经皮跟腱切断治疗马蹄内翻足的术中疗效观察  

Intraoperative observations of tenotomic efficacy for pediatric clubfoot

作　　者：杨征[1] 鲁明[1] 高雷[1] 张宇辰[1] 钱驭涛[1] 闫桂森[1] Yang Zheng;Lu Ming;Gao Lei;Zhang Yuchen;Qian Yutao;Yan Guisen(Department of Pediatric Orthopedics,Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,北京市100035

出　　处：《临床小儿外科杂志》2020年第9期779-784,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的Ponseti方法是目前低龄马蹄内翻足的主要治疗手段,固定畸形矫正主要通过前两个阶段完成,即石膏矫形和腱切断,其中腱切断用来治疗踝关节跖屈畸形。本研究旨在明确此手术的矫正能力,并通过不同月龄、不同畸形程度间的比较,评估此手术的有效性。方法采集北京积水潭医院小儿骨科2015年6月1日至2017年6月1日间所有进行腱切断手术的先天性马蹄内翻足病例资料,收集手术矫正相关数据,并按照两种不同的方式进行分组。第一种按月龄分组,旨在观察随月龄增长,手术效果是否存在不同或有何变化趋势;第二种按原始畸形严重程度分组,旨在观察严重畸形与轻中度畸形的足是否存在手术矫正效果的差异。畸形程度分组采用Pirani评分系统,将≥5分列为重度畸形组,<5分列为轻度畸形组,分别比较不同月龄组间、不同畸形程度组间的差别。结果共有173例符合入组标准的患者进入本研究,其中68例行双侧手术(共136侧),105例行单侧手术(共105侧),合计行经皮跟腱切断术241侧。按月龄共分为9组,不同月龄组间手术效果存在差异(F=9.187,P<0.001)。采用LSD法进行多重比较,3至6月龄间变化幅度较小,组间差异无统计学意义;而其余各组间差异存在统计学意义,根据趋势检验结果证实,越早治疗者手术效果越好,即采用相同的腱切断手术,低月龄患者可获得更大的矫正角度。经分析发现,原始畸形的轻重程度并不会影响经皮跟腱切断这一手术的有效范围(t=0.395,P=0.693)。腱切断的手术有效范围为(35.32±8.283)°。结论腱切断的有效范围在35°左右,且与月龄密切相关,1月龄组在40°左右,7月龄以上组在30°以下;随月龄增加,手术矫正范围下降。跟腱切断手术的矫正能力与原始畸形的轻重程度无关。Objective Currently Ponseti method is a standard treatment for low-age children with talipes equinus.Deformity is mostly corrected through plaster casting and tenotomy and tenotomy of Achilles tendon(TAT)is focused upon plantar flexion.Our study was intended to clarify the corrective capacity of this operation and discuss its effective range(ER)by comparing different monthly ages and varying degrees of deformity.Methods Clinical data were collected for all cases of congenital talipes equinus undergoing tenotomy over the last two years.Patient profiles and related intraoperative data were collected.Two grouping methods were employed used for comparison.Based upon monthly age,the authors observed whether or not there was a correlation between different operative ages and ER and analyze the changing trend of ER with a higher age.Then according to severity of original deformity,whether or not there was a difference in corrective efficacy.Results A total of 173 children fulfilled the inclusion criteria.The operative sideness was bilateral(n=68)and unilateral(n=105).A total of 241 cases of percutaneous Achilles tenotomy were performed.One-way ANOVA was employed for comparing the differences among 9 monthly age groups(F=9.187,P<0.001).Statistical difference existed in perative ER among different groups.Through LSD multiple comparison,there was less variation between 3 to 6 months.However,statistical differences existed among other groups.By data analysis,early treatment yielded better outcomes.For the same operation,low-age children could obtain larger corrective ER.According to the degree of severity,the cases was classified by Pirani score(6 sub-system):≥5 severe while<5 mild.The results of independent-samples T test were as follows:t value 0.395,p value 0.693 and p value>0.05.The severity of original deformity did not affect the value of operative ER.The ER of tenotomy was 35.32±8.283 degrees.Conclusion At approximately 35 degrees,ER of TAT is closely correlated with monthly age.Operative ER decreases with a highe

关 键 词：马蹄足畸形/外科学 跟腱/外科学 外科手术/方法 治疗结果 儿童 

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