中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
3期
222-228
,共7页
常峰%陈斌%荆志振%高刚%李利军%蔚晋斌%秦德安%王小健%余建平%宋洁富%苏云星
常峰%陳斌%荊誌振%高剛%李利軍%蔚晉斌%秦德安%王小健%餘建平%宋潔富%囌雲星
상봉%진빈%형지진%고강%리리군%위진빈%진덕안%왕소건%여건평%송길부%소운성
伊利扎罗夫技术%外固定器%畸形足
伊利扎囉伕技術%外固定器%畸形足
이리찰라부기술%외고정기%기형족
Ilizarov technique%External fixators%Clubfoot
目的 探讨Ilizarov技术矫治复杂僵硬性马蹄内翻足的临床疗效.方法 回顾性分析2005年7月至2011年7月28例(41足)僵硬性马蹄内翻足患者的病例,男18例(26足),女10例(15足)；年龄3～45岁,平均15.3岁；左足8例,右足7例,双足13例.根据Diméglio畸形分级:Ⅲ级31足,Ⅳ级10足.23足采用有限软组织松解、18足配合有限截骨后均安装Ilizarov外固定牵伸器.比较术前及末次随访时踝关节跖屈及背伸角度、踝关节活动度、正侧位X线片上患足距跟角的变化.结果 28例患者均获得随访,随访时间5～38个月,平均25个月.术后外固定支架佩戴2～14个月,平均5.1个月；去除支架后所有患足均获跖行步态,外形接近正常,无足短缩.足背伸角度:术前-45.0°±12.0°,末次随访9.5°±5.5°；跖屈角度:术前67.0°±14.0°,末次随访45.5°±7.8°；正、侧位X线片距跟角:术前分别为6.5°±4.5°和5.5°±11.0°,末次随访分别为22.5°±5.5°和40.6°±8.5°.1足术后发生急性血管痉挛性缺血,予减缓牵伸速度后缓解；5足发生针道感染,予更换针道及换药后感染控制.去支架后3个月,1足出现畸形复发,予二次矫形；3足畸形残留,5足趾屈曲挛缩,均给予二次软组织矫形术,未再复发.结论 Ilizarov技术矫治复杂僵硬性马蹄内翻足疗效确切,能最大程度保留足外形和功能,避免足短缩,不影响足发育.
目的 探討Ilizarov技術矯治複雜僵硬性馬蹄內翻足的臨床療效.方法 迴顧性分析2005年7月至2011年7月28例(41足)僵硬性馬蹄內翻足患者的病例,男18例(26足),女10例(15足)；年齡3～45歲,平均15.3歲；左足8例,右足7例,雙足13例.根據Diméglio畸形分級:Ⅲ級31足,Ⅳ級10足.23足採用有限軟組織鬆解、18足配閤有限截骨後均安裝Ilizarov外固定牽伸器.比較術前及末次隨訪時踝關節蹠屈及揹伸角度、踝關節活動度、正側位X線片上患足距跟角的變化.結果 28例患者均穫得隨訪,隨訪時間5～38箇月,平均25箇月.術後外固定支架珮戴2～14箇月,平均5.1箇月；去除支架後所有患足均穫蹠行步態,外形接近正常,無足短縮.足揹伸角度:術前-45.0°±12.0°,末次隨訪9.5°±5.5°；蹠屈角度:術前67.0°±14.0°,末次隨訪45.5°±7.8°；正、側位X線片距跟角:術前分彆為6.5°±4.5°和5.5°±11.0°,末次隨訪分彆為22.5°±5.5°和40.6°±8.5°.1足術後髮生急性血管痙攣性缺血,予減緩牽伸速度後緩解；5足髮生針道感染,予更換針道及換藥後感染控製.去支架後3箇月,1足齣現畸形複髮,予二次矯形；3足畸形殘留,5足趾屈麯攣縮,均給予二次軟組織矯形術,未再複髮.結論 Ilizarov技術矯治複雜僵硬性馬蹄內翻足療效確切,能最大程度保留足外形和功能,避免足短縮,不影響足髮育.
목적 탐토Ilizarov기술교치복잡강경성마제내번족적림상료효.방법 회고성분석2005년7월지2011년7월28례(41족)강경성마제내번족환자적병례,남18례(26족),녀10례(15족)；년령3～45세,평균15.3세；좌족8례,우족7례,쌍족13례.근거Diméglio기형분급:Ⅲ급31족,Ⅳ급10족.23족채용유한연조직송해、18족배합유한절골후균안장Ilizarov외고정견신기.비교술전급말차수방시과관절척굴급배신각도、과관절활동도、정측위X선편상환족거근각적변화.결과 28례환자균획득수방,수방시간5～38개월,평균25개월.술후외고정지가패대2～14개월,평균5.1개월；거제지가후소유환족균획척행보태,외형접근정상,무족단축.족배신각도:술전-45.0°±12.0°,말차수방9.5°±5.5°；척굴각도:술전67.0°±14.0°,말차수방45.5°±7.8°；정、측위X선편거근각:술전분별위6.5°±4.5°화5.5°±11.0°,말차수방분별위22.5°±5.5°화40.6°±8.5°.1족술후발생급성혈관경련성결혈,여감완견신속도후완해；5족발생침도감염,여경환침도급환약후감염공제.거지가후3개월,1족출현기형복발,여이차교형；3족기형잔류,5족지굴곡련축,균급여이차연조직교형술,미재복발.결론 Ilizarov기술교치복잡강경성마제내번족료효학절,능최대정도보류족외형화공능,피면족단축,불영향족발육.
Objective To evaluate the clinical results of the Ilizarov technique for the treatment of the complex rigid talipes equinovarus deformities.Methods From July 2005 to July 2011,28 patients (41 feet) with rigid talipes equinovarus deformities which had been corrected with the Ilizarov technique were retrospectively analyzed,including 18 males (26 feet) and 10 females (15 feet) with an average age of 15.3 years.According to the classification system proposed by Diméglio,31 feet were categorized as grade Ⅲ,and 10 as grade Ⅳ.We performed corrections with a soft tissue release in 23 feet,and with a limited osteotomy in 18,and then a Ilizarov external fixator was applied.Anteroposterior and lateral X-rays were taken to compare the pre and postoperative data in terms of the angle of plantarflexion and dorsiflexion,the range of motion of the ankle joint,radiological measurements of the talocalcaneal angle.Results All the 28 patients achieved an outpatient follow-up,with an average of 25 months.All patients achieved a plantigrade foot with an almost normal appearance as the fixator was removed after applied for an average of 5.1 months (range,2-14).At the preoperative and final follow-up respectively,the angle of dorsiflexion of the foot was -45.0°±12.0° and 9.5°±5.5°,the angle of plantarflexion was 67.0°±14.0° and 45.5°±7.8°,talocalcaneal angle was 6.5°±4.5° and 22.5°±5.5° in anteroposterior radiograph and 5.5°±11.0° and 40.6°±8.5° in lateral radiograph.Spastic ischemia occurred in one foot and relieved by a slower distraction rate.Wire-hole infections occurred in 5 feet and treated by dressing changs,wire tract altering and antibiotic therapy,finally the infections were controlled.Deformity relapsed in one foot three months after the device was removed,then corrected with an additional fixator application and has not recurred till the final follow-up.Toe contracture and residual deformity occurred in 5 feet and 3 feet,respectively.Conclusion The Ilizarov technique is an effective method for correction of complex rigid talipes equinovarus deformities,with which the appearance and function of the foot could be kept as much as possible,and without impact on food development.
