中国修复重建外科杂志

中国修复重建外科杂志

成人脊柱裂后遗感觉缺失性连枷足的治疗策略

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目的 评价有限手术结合外固定技术治疗脊柱裂后遗感觉缺失性连枷足的综合疗效,探讨该类型足畸形的治疗策略。 方法 回顾分析 2005 年 1 月—2015 年 12 月应用有限手术结合外固定技术治疗的 22 例(30 足)成人脊柱裂后遗感觉缺失性连枷足患者临床资料。其中男 14 例,女 8 例;年龄 18~38 岁,平均 21.5 岁。均为踝关节以远感觉缺失。左侧 2 例 2 足,右侧 2 例 2 足,双侧 18 例 26 足。1 足伴足底负重区溃疡,3 足因既往足骨髓炎致足趾缺失。合并髋关节脱位 3 例,脊柱侧弯 3 例,膝关节畸形 4 例,ル趾下垂畸形 3 例。二便正常控制 5 例,二便大部分控制 10 例,充溢性尿失禁 6 例,膀胱造瘘 1 例。X 线片示椎板闭合不全位于 L3~L5 8 例,L5、S1 9 例,L3~S3 5 例。行踝关节融合 12 足,跟距关节融合 10 足;8 足踝关节与跟距关节均明显松弛,行踝关节+跟距关节融合术。使用 Ilizarov 外固定器 18 足,使用组合式外固定器 8 足,组合式外固定器联合空心钉内固定 3 足,Ilizarov 外固定器联合空心钉内固定 1 足。 结果22 例患者均获随访,随访时间 10~80 个月,平均 48.5 个月。所有足踝畸形术后均得到有效矫正,中后足稳定,恢复跖行足,全足负重,溃疡愈合无复发。发生胫距关节空心螺钉断裂 2 例,空心钉断裂后骨愈合;未出现手术相关的感染、神经血管损伤等并发症。末次随访时采用秦泗河畸形矫正残缺修复与功能重建术后疗效评价表进行评价,优 15 足,良 9 足,可 6 足,优良率 80.0%。 结论有限手术结合骨外固定技术治疗成人脊柱裂后遗感觉缺失性连枷足,可获得足踝关节的跖行静力稳定,风险小,并发症少,临床效果良好。

Objective To summarize the main methods and comprehensive effects of limited surgery combined with external fixation for the treatment of flail foot with sensory disorder of spina bifida sequela in adult. Method The clinical data of 22 cases (30 feet) of the adult spina bifida sequela who suffered from flail foot with sensory disorder and treated by limited surgery combined with external fixation were retrospectively analysed between January 2005 and December 2015. There were 14 males and 8 females with an age of 8-38 years (mean, 21.5 years). All 30 feet were distal ankle sensory loss, including 2 cases (2 feet) on the left side, 2 cases (2 feet) on the right side, and 18 cases (26 feet) on both sides. There was 1 foot accompanied by ulcerative plantar ulcers, and 3 feet lost their toes due to foot osteomyelitis in the weight-bearing area. Combined with 3 cases of hip dislocation, 3 cases of scoliosis, 4 cases of knee deformity, and 3 cases of ptosis. There were 5 cases of normal control of urine and stool, 10 cases of partial control of urine and stool, 6 cases of overflow urinary incontinence, and 1 case of cystostomy. According to X-ray film, the lesion of spina bifida was evaluated, the laminar insufficiency was located at L3-L5 in 8 cases, L5, S1 in 9 cases, and L3-S3 in 5 cases. In the patients, 12 feet were performed ankle joint arthrodesis, 10 feet subtalar arthrodesis, and 8 feet tibia-talus-calcaneus arthrodesis. Ilizarov external fixator was used in 18 feet, Hybrid fixator in 8 feet, Hybrid fixator and cannulate screws in 3 feet, and Ilizarov fixator and cannulate screws in 1 foot. Results All 22 patients were followed up 10-80 months (mean, 48.5 months). All ankle deformities were corrected effectively after operation, the middle and hind feet were stable, the plantar foot was restored, the whole foot was loaded, and the ulcer healed without recurrence. There were 2 cannulate screws ruptured in the subtalar arthrodesis, bone healed after screws break; no complication such as surgical infection, neurovascular injury, and so on happened. At last follow-up, based on the evaluation criteria of QIN Sihe lower limb deformity correction, the results were excellent in 15 feet, good in 9 feet, and fair in 6 feet, with an excellent and good rate of 80.0%. Conclusion The treatment of flail foot with sensory disorder of spina bifida sequela is more demanding. The limited surgeries combined with external fixation play an important role for recovering the stability of foot and ankle, better clinical results, and less complications.

关键词: 外固定; Ilizarov 技术; 脊柱裂; 足踝畸形; 连枷足; Charcot 关节病

Key words: External fixation; Ilizarov technology; spina bifida; ankle malformation; flail foot; Charcot arthropathy

引用本文: 臧建成, 秦泗河, 秦绪磊, 石磊, 吕泽平. 成人脊柱裂后遗感觉缺失性连枷足的治疗策略. 中国修复重建外科杂志, 2018, 32(10): 1255-1260. doi: 10.7507/1002-1892.201808076 复制

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