泰勒空间外架技术结合足部“U”形截骨治疗创伤后马蹄内翻足畸形  

Correction of posttraumatic talipes equinovarus deformity with Taylor spatial frame and scythe⁃shaped osteotomy

作　　者：杨敬 王强 朱伟 何保华 赵鹏 商玉臣 杜辉[2] YANG Jing;WANG Qiang;ZHU Wei;HE Bao-hua;ZHAO Peng;SHANG Yu-chen;DU Hui(Department of Orthopaedics,Emergency General Hospital,Beijing 100028,China;Department of Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]应急总医院骨科,北京100028 [2]北京积水潭医院矫形外科,北京100035

出　　处：《骨科》2021年第3期200-205,共6页ORTHOPAEDICS

摘　　要：目的探讨泰勒空间外架(Taylor spatial frame,TSF)技术结合足部“U”形截骨治疗创伤后马蹄内翻足的临床疗效。方法回顾性分析2016年7月至2019年7月应急总医院收治的42例创伤后马蹄内翻足病人的临床资料,其中男31例,女11例,平均年龄为24.3岁。马蹄足畸形平均跖屈70°。术前测量畸形参数。术中依据Ilizarov穿针原则安装TSF,足部“U”形截骨同期行微创软组织松解术。术后根据处方调整TSF,行康复训练。截骨处愈合后去除外固定架,佩戴支具。定期门诊复查,记录疼痛视觉模拟量表(visual analogue scale,VAS)评分及美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分。结果本组平均手术时间为85.6 min(60~110 min),术中平均出血量为15.5 mL(10~20 mL)。42例病人均获随访,平均随访时间为18个月(12~24个月)。术后平均40.7 d(26~80 d)踝关节恢复背伸5°~10°;佩戴外支架行走时间平均为12.7周(10~16周)。5例病人6处针道轻度感染。1例发生近端半针断裂。所有病人无血管、神经损伤。3例患足复发跖屈畸形,约10°。随访结束时所有病人均可达到不扶拐步行状态。末次复诊时AOFAS评分,优18例,良18例,可4例,差2例,优良率为85.7%;AOFAS评分为(89.4±8.0)分,较术前(52.7±1.0)分显著增加,差异有统计学意义(t=-6.085,P=0.010)。VAS评分为(2.8±1.3)分,较术前的(6.7±1.4)分明显降低,差异有统计学意义(t=0.464,P=0.025)。结论TSF结合足部“U”形截骨是治疗创伤后马蹄内翻足畸形的有效方法。Objective To explore the clinical effect of Taylor spatial frame(TSF)technique combined with scythe⁃shaped osteotomy on foot in the treatment of posttraumatic talipes equinovarus.Methods From July 2016 to July 2019,we applied TSF to treat 42 patients with a posttraumatic talipes equinovarus deformity.The mean age was 24.3 years.There were 31 males and 11 females.The average plantar flexion of deformity was 70°.The deformity parameters were measured before operation.TSF was installed according to Ilizarov􀆳s principle,and U⁃shaped osteotomy was performed at the same time.After operation,TSF was adjusted according to the prescription and rehabilitation training was carried out.The external fixator was removed after the osteotomy healed.Then an orthosis was worn.The visual analogue scale(VAS)and American Orthopaedic foot and Ankle Society(AOFAS)ankle and hindfoot function scores were recorded.Results In this group,the operation time was 85.6 min(60⁃110 min),the intraoperative bleeding volume was 15.5 mL(10⁃20 mL).42 cases were followed up for 12 to 24 months,with an average of 18 months.The joint range of motion recovered to 5°⁃10°dorsiflexion on average 40.7 d(26⁃80 d)after operation,and walked for 12.7 weeks(10⁃16 weeks)with external fixation.There were 6 cases of slight pin infection in 5 patients,and 1 case of breaking of half⁃pin after falling.All patients had no vascular and nerve injury.Three patients failed to follow the advice to wear orthosis and exercise,and relapse occurred after operation.The plantar flexion deformity was about 10°.At the last follow⁃up,all patients could walk normally without crutches.The AOFAS score was 89.4±8.0,which was significantly higher than the preoperative score of 52.7±1.0,and the difference was statistically significant(t=-6.085,P=0.010).The AOFAS score was excellent in 18 cases,good in 18 cases,fair in 4 cases,poor in 2 cases,and the excellent and good rate was 85.7%.The VAS score was 2.8±1.3,which was significantly lower than that before operatio

关 键 词：马蹄内翻足 泰勒空间外架 外固定架 “U”形截骨 

分 类 号：R658.3[医药卫生—外科学]