关节镜下腓肠肌腱膜松解术治疗痉挛性马蹄足畸形  

Arthroscopic gastrocnemius aponeurotic release for the treatment of spastic equinus deformity

作　　者：肖保辉 肖汉 雷霆 刘政 蔡豪杰 刘昆 叶卫华 唐进 梅海波 赵卫华 朱光辉 严安 Xiao Baohui;Xiao Han;Lei Ting;Liu Zheng;Cai Haojie;Liu Kun;Ye Weihua;Tang Jin;Mei Haibo;Zhao Weihua;Zhu Guanghui;Yan An(Department of Orthopedics,Central South University Xiangya Medical College Affiliated Children’s Hospital,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)骨科,长沙410007

出　　处：《临床小儿外科杂志》2024年第9期837-840,共4页Journal of Clinical Pediatric Surgery

基　　金：儿童骨科学湖南省重点实验室, 湖南省卫健委科研课题(20200021)。

摘　　要：目的评价关节镜下腓肠肌腱膜松解术治疗痉挛性马蹄足畸形的临床疗效。方法回顾性分析湖南省儿童医院骨科自2020年12月至2022年11月采用关节镜下腓肠肌腱膜松解术治疗的17例痉挛性马蹄足畸形患儿临床资料。测量手术前、术后2周、术后3个月、术后1年踝关节最大被动背伸角和手术时长, 观察术后有无伤口感染、跖屈力量下降及伤口周围痛性瘢痕等并发症。结果共计17例21足纳入本研究, 其中男10例、女7例;双侧4例、左侧11例、右侧2例。手术时年龄为(75.2±25.3)个月。手术时长(25±3.6)min。术前踝关节最大被动背伸角度(-11.62±5.74)°, 术后2周踝关节最大被动背伸角度(11.62±1.98)°;术后3个月踝关节最大被动背伸角度(11.52±1.89)°;术后1年踝关节最大被动背伸角度(12.76±3.51)°;踝关节最大被动背伸角度术前与术后2周、术后3个月、术后1年比较, 差异均有统计学意义(P<0.05)。术后无一例出现伤口感染、踝关节跖屈力量明显下降、腓肠神经麻痹或伤口周围痛性瘢痕等。结论关节镜下腓肠肌腱膜松解术治疗痉挛性马蹄足畸形是一种安全有效的治疗方案, 但远期效果仍需进一步随访。Objective To evaluate the clinical efficacy of arthroscopic gastrocnemius aponeurotic release in the treatment of spastic equinus deformity.Methods A retrospective analysis was conducted on the clinical data of 17 pediatric patients with spastic equinus deformity who underwent arthroscopic gastrocnemius aponeurotic release in the Department of Orthopedics at Hunan Children’s Hospital from December 2020 to November 2022.The maximum passive dorsiflexion angle of the ankle joint and the duration of surgery were measured preoperatively,at 2 weeks,3 months,and 1 year postoperatively.Postoperative complications such as wound infection,decreased plantarflexion strength,and painful scars around the wound were observed.Results A total of 17 cases(21 feet)were included in the study,with 10 males and 7 females;4 cases were bilateral,11 were left-sided,and 2 were right-sided.The average age at surgery was 75.2±25.3 months.The average surgery duration was 25±3.6 minutes.The preoperative maximum passive dorsiflexion angle of the ankle joint was-11.62±5.74°,which improved to 11.62±1.98°at 2 weeks postoperatively.11.52±1.89°at 3 months postoperatively,and 12.76±3.51°at 1 year postoperatively.The differences between the preoperative and postoperative maximum passive dorsiflexion angles at 2 weeks,3 months,and 1 year were statistically significant(P<0.05).No cases of wound infection,significant decrease in ankle plantarflexion strength,sural nerve palsy,or painful scars around the wound were observed postoperatively.Conclusions Arthroscopic gastrocnemius aponeurotic release is a safe and effective treatment for spastic equinus deformity,though long-term outcomes require further follow-up.

关 键 词：马蹄足畸形 痉挛 腓肠肌 肌腱松解术 关节镜手术 

分 类 号：R68[医药卫生—骨科学]