分期个体化治疗重度马蹄内翻足合并下肢复杂畸形的临床疗效  

Clinical efficacy of staged individualized treatment of severe clubfoot deformity

作　　者：王尚龙 段宜强 方舟 WANG Shanglong;DUAN Yiqiang;FANG Zhou(Clinical Medical College of Guizhou Medical University,Guiyang,Guizhou 550004,China;Department of Joint Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550004,China)

机构地区：[1]贵州医科大学临床医学院,贵阳550004 [2]贵州医科大学附属医院关节外科,贵阳550004

出　　处：《重庆医学》2024年第15期2319-2323,共5页Chongqing Medical Journal

摘　　要：目的探讨采用分期个体化手术方式治疗神经源性重度马蹄内翻足合并复杂下肢畸形的临床疗效。方法收集2021年5月至2023年6月于贵州医科大学附属医院医治的10例神经源性重度马蹄内翻足合并下肢复杂畸形患者为研究对象,采用一期行软组织松解、肌腱转移联合Ilizarov技术矫正马蹄内翻畸形,二期根据患者术后步态及下肢畸形程度予以个体化适量截骨辅助增加Ilizarov外架延长、踝上截骨术及股骨远端截骨术等相关手术治疗。观察患者临床治疗结果,比较患者术前及术后1、3、6、12、18个月踝关节美国足踝外科协会(AOFAS)评分、视觉模拟评分法(VAS)评分,比较术前及术后18个月下肢生物力线相关影像学参数。结果所有患者均顺利完成手术,术中及术后均为未出现神经、血管损伤,无针道口、切口感染等严重并发症。所有患者随访时间16~24个月。术后各时间点AOFAS评分较术前查体时增加(P<0.05),VAS评分较术前查体时降低(P<0.05)。术后18个月下肢生物力线相关影像学参数均较术前明显改善(P<0.05)。结论分期个体化手术方式治疗神经源性重度马蹄内翻足合并复杂下肢畸形可取得较满意的治疗效果。Objective To investigate the clinical efficacy of staged individualized surgical method for treating neuromuscular origin severe clubfoot complicating complex lower limb deformity.Methods Ten cases of neurogenic severe clubfoot deformity treated in the Affiliated Hospital of Guizhou Medical University from May 2021 to June 2023 were collected as the research subjects.In the first stage,the soft-tissue release,tendon transfer combined with Ilizarov technique were adopted to correct the clubfoot deformity,and in the second stage,according to the patients’postoperative gait and the degree of lower limb deformity,the patients were given individualized and appropriate osteotomy assisted by the increase of Ilizarov external frame lengthening,supra-ankle osteotomy,and distal femoral osteotomy.The clinical results of treatment in the patients were observed.The American Orthopaedic Association Division of Foot and Ankle Surgery(AOFAS)scores and visual analog scale(VAS)scores were compared between before operation and 1,3,6,12 and 18 months after operation.The lower extremity biodynamic line related imaging parameters were compared between before and 18 months after operation.Results All patients successfully completed the surgery without nerve or vascular injury during and after operation and there were no serious complications such as pinhole or incision infection.All patients were followed up for 16-24 months.The ankle joint AOFAS score at each time point after operation was increased compared with the physical examination before operation(P<0.05),and the VAS score was decreased compared with the physical examination before operation(P<0.05).The lower extremity biodynamic line related imaging parameters at 18 months after operation were significantly improved compared with before operation(P<0.05).Conclusion Adopting the staged individualized surgical method for the treatment of neuromuscular origin severe clubfoot complicating complex deformity of the lower limbs could achieve more satisfactory and relatively ideal t

关 键 词：神经源性重度马蹄内翻足 ILIZAROV技术 软组织手术 骨性截骨 下肢畸形 分期手术 

分 类 号：R615[医药卫生—外科学]