Ilizarov技术联合经皮切腱术治疗儿童复发性先天性僵硬型马蹄内翻足  

Ilizarov Technique for the Treatment of Recurrent Stiff Congenital Clubfoot in Children

作　　者：姚满叶 张春旭 刘方娜 Weyland Cheng 李伟笠 孙维胜 Yao Manye;Zhang Chunxu;Liu Fangna(Department of Orthopaedic Surgery,Henan Children's Hospital,Zhengzhou 450018,China)

机构地区：[1]河南省儿童医院郑州儿童医院,郑州大学附属儿童医院骨科,河南郑州450018

出　　处：《实用骨科杂志》2021年第5期428-432,共5页Journal of Practical Orthopaedics

摘　　要：目的评估Ilizarov改良足踝构型治疗儿童复发性先天性僵硬型马蹄内翻足的疗效。方法2012年6月至2018年9月河南省儿童医院郑州儿童医院骨科应用Ilizarov技术治疗儿童复发性先天性僵硬型马蹄内翻足25例37足,男21例,女4例;年龄3岁4个月~12岁,平均(7.22±2.2)岁;左侧7例,右侧6例,双侧12例;包括已行胫前肌转移至第3楔骨1例2足。在Ilizarov足踝构型的基础上,足内外侧螺杆的3个固定栓与Ilizarov架形成微动联接,第1跖骨内下方交叉穿针;经皮跟腱或经皮腓肠肌腱膜切断。矫正标准:足弓外观完全矫正,踝关节外翻5°~10°、背伸20°。结果25例37足(Ilizarov矫形及拆架时转移胫前肌至第3楔骨6例9足)均达到矫正标准。带架4~7个月,平均(4.7±0.8)个月。并发症:针道感染4例,外翻足1例2足,钢针割裂跟骨3例5足,中足疼痛1例1足。失访2例3足。23例34足拆架后获得随访0.9~8.5年,平均(2.83±2.16)年。25足步态正常,7足踇趾内收。按Garceau标准评定疗效,优25足,良7足,2足外翻不适宜本标准评价。结论Ilizarov技术可彻底矫正儿童复发性先天性僵硬型马蹄内翻足,微创、美观。Objective To evaluate the efficacy of modified Ilizarov technique in the treatment of recurrent congenital clubfoot with stiffness in children.Methods From June 2012 to September 2018,the Ilizarov technique was used to treat 25 children with recurrent stiff congenital clubfoot in Henan Children's Hospital,including 7 cases on the left foot,6 cases on the right foot,and 12 cases on both feet totaling 37 feet.There were 21 males and 4 females,among which one case with two feet already underwent transfer of the tibialis anterior tendon.The average age was(7.22±2.2)years old(range:3 years 4 months to 12 years old).On the basis of Ilizarov's ankle configuration,three fixation bolts of the internal and external screws along with the Ilizarov frame formed a micro-motion connection.The first metatarsal bone was cross stitched and percutaneous Achilles tenotomy or percutaneous gastrocnemius aponeurosis was conducted.Correction criteria consisted of complete arch correction,5°~10°ankle valgus and 20°dorsiflexion.Results 37 feet of 25 cases reached the correction standard.At Ilizarov reconstruction and disassembly of fixation,tibialis anterior tendon was transferred to the third cuneiform in 6 cases and 9 feet.Fixation lasted 4~7 months with an average of(4.7±0.8)months.Complications included needle tract infections in 4 participants;valgus foot in 1 participant and 2 feet;steel needle splitting the calcaneus in 3 participants and 5 feet;and midfoot pain in 1 participant and 1 foot.Two participants with 3 feet were lost to follow-up.23 participants with 34 feet were followed up after removal of fixation from eleven months to eight and a half years,with an average follow-up period of(2.83±2.16)years.25 feet had normal gait and 7 feet had hallux adduction.According to the Garceau standard,the curative effect was evaluated as excellent in 27 feet,good in 7 feet.Two feet did not qualify for this standard due to valgus.Conclusion The Ilizarov technique can completely correct children's recurrent stiff congenital clubfoot.I

关 键 词：ILIZAROV技术 复发性 僵硬型 先天性马蹄内翻足 

分 类 号：R687.3[医药卫生—骨科学]