中国修复重建外科杂志

中国修复重建外科杂志

Ilizarov 技术治疗大龄儿童僵硬型先天性马蹄内翻足

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目的 探讨 Ilizarov 技术治疗大龄儿童僵硬型先天性马蹄内翻足的效果。 方法 回顾性分析 2005 年 9 月—2015 年 9 月收治的 55 例(69 足)僵硬型先天性马蹄内翻足(Diméglio Ⅳ型)患儿临床资料。男 33 例,女 22 例;年龄 6~14 岁,平均 11 岁。单侧 41 例,双侧 14 例。术前根据国际马蹄足畸形研究学组(ICFSG)评价标准,一般 24 足,差 45 足。采用 Ilizarov 外固定架结合有限软组织松解治疗,其中 21 足结合个体化 V 形截骨治疗。 结果 患儿均获随访,随访时间 2~10 年,平均 4.2 年。术后切口愈合良好。5 例发生针道感染,经局部换药治愈。根据 ICFSG 评价标准评价疗效,获优 39 足、良 21 足、一般 9 足,优良率 87.0%。X 线片复查示,随访期间无距骨、舟骨、楔骨、跖骨、跟骨、骰骨血供障碍及坏死,无骨髓炎发生。 结论 对于大龄儿童僵硬型先天性马蹄内翻足,采用 Ilizarov 外固定架技术结合有限软组织松解或 V 形截骨矫正,安全且矫形效果显著。

Objective To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.

关键词: 儿童; 僵硬型先天性马蹄内翻足; Ilizarov 技术; 软组织松解

Key words: Child; rigid congenital clubfoot; Ilizarov technique; soft tissue release

引用本文: 刘行, 李明, 刘星, 罗聪, 曹豫江, 刘传康, 瞿向阳. Ilizarov 技术治疗大龄儿童僵硬型先天性马蹄内翻足. 中国修复重建外科杂志, 2018, 32(10): 1267-1270. doi: 10.7507/1002-1892.201805005 复制

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