Ilizarov技术微创治疗儿童僵硬型马蹄内翻足

目的探讨利用Ilizarov外固定架治疗儿童僵硬型马蹄内翻足畸形的临床疗效及影像学评估。方法 2009年1月至2012年6月利用Ilizarov外固定架治疗25例30足儿童僵硬性马蹄内翻足畸形患者,术前对患者进行常规足部X线检查,测量正位跟距角(talocalcaneal angle of anteroposterior radiograph,TCA-AP)、侧位跟距角(talocalcaneal angle of lateral radiograph,TCA-LAT)、正位距骨-第1跖骨角(talo-first metatarsal angle of anteroposterior radiograph,TMT1-AP),根据患者实际情况选择合适的外固定架,术中按照Ilizarov固定原则固定于患者胫骨及足部相应位置。术后第5天开始调整外固定架螺母,以1 mm/d,6次/d的幅度进行调整,直至畸形得到完全纠正,并适当过伸。将患足固定于过伸矫正位4~6周,期间佩戴外固定架行走。拆除外固定后定期复查X线,测量并对比相关数据。结果 25例患者均得到随访,随访时间8个月~2年,平均随访12个月。所有患者调整外固定架矫形期间均未见血管神经损伤等症状。术后5~7周踝关节恢复到中立位,平均固定时间14周。按Garceau标准评定,优23足,良4足,差3足。治疗前后比较,TCA-AP、TCA-LAT明显增大(P0.001),TMT1-AP明显减小(P0.001),差异均有统计学意义。结论 Ilizarov技术对于儿童僵硬型马蹄足治疗效果明显,具有微创、安全、操作简单等优点,且影像学数据改善明显,可作为评价矫形效果的有效指标。

Treatment of Rigid Talipes Equinovarus Deformity with Llizarov Technique

Objective To study the clinical effect and radiological evaluation of Ilizarov technique in treatment of severe rigid talipes equinovarus deformity. Methods Between January 2009 and June 2012,25 patients（30 feet）with rigid talipes equinovarus were treated with Ilizarov external fixtor. We took preoperative foot X-ray examination and recorded the angle from the patients′radiographs,choose the external fixtor according to the patient′s condition. Ilizarov external fixator was placed in relative position of the foot and leg during operation. The nuts were adjusted from 5 days after operation with range of 1 mm in 4 times per day. Then distraction stopped when the ankle was corrected at the position of appropriate hyperextension. The af-fected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. Foot X-ray was taken after removal of the external fixation to measure the angles and compare with the preoperative data. Results All patients were followed up 8 months to 2 years with an average of 12 months. There is no neurovascular injury and other complications occurred during the whole orthopedic process. The deformity was corrected 5 to 7 weeks after the treatment of Ilizarov tech-nique,the average fixation time was 14 weeks. According to the Garceau standard scale,the result was excellent in 23 feet,good in 4 feet,poor in 3 feet. The mean of the overall TCA-AP and TCA-LAT angle values increased（P〈0. 001）. The mean of the overall TMT1-AP angle values decreased（P〈0. 001）. Conclusion Ilizarov technique is an effective method of treating rigid talipes equinovarus deformity with advantages of minimally invasive,safe and simple. There is a significant improvement in ra-diographic measurements after treatment.