胫后肌与腓骨短肌平衡前移术在儿童高弓内翻足治疗中的应用  

Treatment of pediatric cavovarus foot with balance anterior transfer of tibialis posterior and peroneus brevis

作　　者：杨劼[1] 杨征[1] 闫桂森[1] 龚晓峰[1] Yang Jie;Yang Zheng;Yan Guisen;Gong Xiaofeng(Department of Pediatric Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,北京100035

出　　处：《临床小儿外科杂志》2022年第3期248-252,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市属医院科研培育计划项目(PX20210402)。

摘　　要：目的 介绍胫后肌、腓骨短肌平衡前移术在儿童高弓内翻足治疗中的应用,总结其操作方法、适应证及临床疗效。方法 以北京积水潭医院小儿骨科2016—2018年收治的21例高弓内翻足患儿为研究对象,共25足;手术时患儿年龄(11.10±2.08)岁,随访(4.37±1.14)年。通过足部软组织松解、截骨治疗(骰骨、内侧楔骨或中跗关节截骨等)矫正足部畸形,畸形矫正后通过胫后肌、腓骨短肌平衡前移,平衡足部内、外侧肌肉力量。使用克氏针固定截骨端及踝关节,术后石膏固定六周;术后一年通过佩戴可行走支具及手法按摩巩固疗效。术前、术后随访均拍摄负重位足正侧位及踝关节正侧位X线片。采用美国矫形外科足踝协会(American Orthopedic Foot&Ankle Society, AOFAS)踝-后足评分及踝足功能(foot and ankle ability measure, FAAM)评分评价足踝功能。结果 经过手术治疗,21例均能恢复正常负重行走。1例术后畸形复发,行进一步手术治疗;1例出现皮肤坏死,换药后愈合。Kite角术前、术后、末次随访(术后3年以上)结果差异无统计学意义(F=1.973,P=0.162)。Hibbs角术前、术后、末次随访结果差异有统计学意义(F=63.831,P<0.001),通过两两比较发现,术前与术后、末次随访Hibbs角差异均有统计学意义(P<0.001),但术后、末次随访Hibbs角差异无统计学意义(P>0.05)。Meary角和跟骨矩角术前、术后、末次随访结果差异有统计学意义(P<0.001),且随着时间推移,Meary角和跟骨矩角有逐渐减小的趋势。AOFAS评分及FAAM评分的术前、术后、末次随访结果差异均有统计学意义(P<0.05)。结论 胫后肌、腓骨短肌平衡前移术治疗儿童高弓内翻足操作简单,足内、外侧背屈力量平衡效果满意,可以较好地维持手术后足部畸形矫正效果。Objective To explore the application of balance anterior transfer of tibialis posterior muscle and fibula brevis muscle in the treatment of pediatric cavovarus foot and summarize its operative approaches,technical advantages and long-term outcomes.Methods Twenty-one children with 25 feet of cavovarus foot were treated.The operative age was(11.10±2.08) years and the average follow-up period(4.37±1.14) years.Through surgical soft tissue release,osteotomy(cuboid,medial cuneiform or midtarsal joint osteotomy,etc.) was employed for correcting foot deformity.Transfer advancement of tibialis posterior muscle and peroneus brevis muscle was performed for balancing the strength of foot;Kirschner wire was utilized for fixing osteotomy and cast applied for 6 weeks post-operation.At Year 1 post-operation,therapeutic effect was consolidated by wearing a walking brace and manual massage.During follow-ups,radiological films of weight-bearing foot were taken and angles measured.Foot and ankle functions were evaluated by the scores of American Orthopedic Foot and Ankle Association(AOFAS) Ankle-Posterior Foot and Foot and Ankle Ability Measure(FAAM).Results Through comparing radiological manifestations,appearance and functional status of feet before,after and during follow-ups,all of them resumed walking with weight-bearing.One case of recurrent malformation was re-operated.Another case of skin deficit healed after dressing change.No significant difference existed in Kite angle before,after and at the last follow-up(>3 years post-operation)(F=1.973,P=0.162).The differences of Hibbs angle before,after and at the last follow-up(>3 years post-operation) were statistically significant(F=63.831,P<0.001).By pair comparison,mean values before and after operation and at the last follow-up(>3 years post-operation) were statistically different from each other while mean values post-operation and at the last follow-up(>3 years post-operation) were statistically different from each other.Statistically significant differences existed in Meary

关 键 词：马蹄足/外科学 矫形外科手术/方法 治疗结果 儿童 

分 类 号：R726.8[医药卫生—儿科]