Dobbs法治疗特发性与非特发性幼龄先天性垂直距骨临床疗效对比  

Dobbs method for treatment of congenital vertical talus in young children:Comparison of clinical efficacy between idiopathic and non-idiopathic children

作　　者：杨明[1,2] 燕华 孙川 梁小菊[1] 李敏[1] 李旭[2,3] 颉强 Yang Ming;Yan Hua;Sun Chuan(Children's Osteopathy Hospital,the Affiliated Honghui Hospital of Xi'an Jiaotong Uniwersity,Xi'an 710054,China;Department of Pediatric Orthopedics,the Third Affiliated Hospital of Southern Medical U-niversity,Guangzhou 510630,China;Department of Pediatric Orthopedics,Shantou University Guangzhou Huaxin Orthopaedic Hospital,Guangzhou 510630,China)

机构地区：[1]西安交通大学附属红会医院儿童骨病医院,西安710000 [2]南方医科大学第三附属医院儿童骨科,广东省骨科医院,广东省骨科研究院,广州510630 [3]汕头大学广州华新骨科医院,广州510630

出　　处：《美中国际创伤杂志》2023年第1期1-8,24,F0003,共10页U.S.Chinese International Journal of Traumatology

摘　　要：目的:探讨Dobbs法治疗幼龄先天性垂直距骨的方法技巧及临床疗效,比较特发性组与非特发性组的疗效差异。方法:回顾性分析2012年7月至2015年12月就诊于我院的先天性垂直距骨患儿11例(18足),其中男8例,女3例,特发性组5例(9足),非特发性组6例(9足),平均手术年龄10.9个月(3.9-31.2个月)。所有患儿均多次反式Ponseti序列石膏矫形,经皮逆行穿针固定或微创切开复位固定距舟关节,经皮延长跟腱,石膏固定治疗。比较两组患儿末次随访时踝关节、距下关节活动度,以及术前、术后即刻、末次随访时的影像学测量参数。采用Adelar评分评估患儿治疗后的整体疗效。结果:11例(18足)患儿在平均随访27个月(12-57个月)后,所有足部畸形都得到不同程度矫正,内侧纵弓恢复,后足无明显外翻,踝关节和距下关节无明显功能障碍。仅非特发性组中2例(4足)术后6个月内出现畸形复发,随后再次经序列石膏矫形、微创手术后畸形矫正,无需广泛松解手术。末次随访时,特发性组踝关节活动度优于非特发性组(P<0.05),所有的影像学测量结果较术前均有改善(P<0.05),两组间差异无统计学意义(P>0.05)。根据Adelaar评分,2足为优,15足为良,1足为中。所有患儿均无伤口坏死、关节僵硬、距骨坏死等并发症。结论:Dobbs法是一种有效治疗幼龄先天性垂直距骨的新方法,就足的临床外观、功能以及影像学测量等方面,与传统广泛松解手术相比具有创伤小、疗效可靠、并发症少等优点,可获得良好的早期临床效果。Objective:To explore the clinical efeet and surgical skills of Dobbs method for young children with congenital vertical talus(CVT),and compare the difference between idiopathic and non-idiopathic patients.Methods:Between July 2012 and December 2015,11 consecutive patients(18 feet)with congen-ital vertical talus were retrospectively reviewed,following treatment with Dobbs method.There were 8 boys and 3 girls,including 5 patients(9 feet)with idiopathic CVT and 6 patients(9 feet)with non-idiopathic CVT,with an average age of 10.9 months(range,3.9-31.2 months).All patients were treated with multi-ple trans-ponseti sequence gypsum orthoses,percutaneous retrograde pin fixation or minimally invasive re-duction and fixation of the scaphoid joint,percutaneous lengthening of the Achilles tendon and plaster im-mobilization.The range of motion(ROM)of ankle joint and subtalar joint at the last follow-up,and the imaging parameters before operation,immediately after operation and at the last follow-up were compared between the two groups.Adelaar score was used to evaluate the overall efficacy of the treatment.Results:11 cases(18 feet)were followed up for an average of 27 months(12-57 months).All foot deformities were corrected to some extent,the medial longitudinal arch recovered,and the posterior foot did not val-gus,there was no obvious dysfunction of ankle and subtalar joints.In the non-idiopathic group,2 patients(4 feet)developed recurrent deformity within 6 months after operation,and were subsequently treated with sequential plaster procedure and minimally invasive surgery.At the last follow-up,the ankle range of motion in the idiopathic group was better than that in the non-idiopathic groupp(P<0.05),and all the radiographic results were improved(P<0.05).There was no significant difference between the two groups(P>0.05).According to Adelaar score,2 feet were excellent,15 feet were good and 1 foot was fair.There were no complications such as wound necrosis,joint stiffness and talus necrosis happed.Conclusion:The Dobbs metho

关 键 词：垂直距骨 先天性 Dobbs方法 微创外科手术 特发性 

分 类 号：R68[医药卫生—骨科学]