CAJ | 학술논문

目的：探讨一种早期微创治疗婴儿先天性垂直距骨(congenital vertical talus, CVT)的方法及其疗效。方法自2008年1月~2011年12月共治疗11例16足先天性垂直距骨，男7例，女4例，双侧5例；年龄为7 d~8个月，平均3.2个月；采用系列手法，阶段性石膏矫形，然后在全麻下经皮跟腱切断，闭合复位，C型臂引导下经皮距舟关节克氏针内固定。结果术后随访16~34个月，平均22个月，术后按照Adelaar评分标准评价治疗效果，优2足，良11足，可2足，差1足。1足复发，2足舟状骨半脱位。结论该方法通过系列手法，石膏矫形，以及经皮跟腱切断、距舟关节克氏针内固定，是一种保守治疗结合微创手术，疗效好，术后可获得良好的足外观和足踝部功能，无关节僵硬、距骨坏死等并发症，尤其适合年龄<6个月的特发性先天性垂直距骨的早期治疗。
목적：탐토일충조기미창치료영인선천성수직거골(congenital vertical talus, CVT)적방법급기료효。방법자2008년1월~2011년12월공치료11례16족선천성수직거골，남7례，녀4례，쌍측5례；년령위7 d~8개월，평균3.2개월；채용계렬수법，계단성석고교형，연후재전마하경피근건절단，폐합복위，C형비인도하경피거주관절극씨침내고정。결과술후수방16~34개월，평균22개월，술후안조Adelaar평분표준평개치료효과，우2족，량11족，가2족，차1족。1족복발，2족주상골반탈위。결론해방법통과계렬수법，석고교형，이급경피근건절단、거주관절극씨침내고정，시일충보수치료결합미창수술，료효호，술후가획득량호적족외관화족과부공능，무관절강경、거골배사등병발증，우기괄합년령<6개월적특발성선천성수직거골적조기치료。
Objective:To investigate and evaluate a new method of early minimal y invasive treatment for congenital vertical talus in infants. Methods:The cases of eleven consecutive patients who had a total of sixteen feet with congenital vertical talus deformity were retrospectively reviewed at a minimum of sixteen months fol owing treat-ment with serial manipulations and casts fol owed by limited surgery consisting of percutaneous Achil es tenotomy, and closed reduction,and then percutaneous pin fixation of the talonavicular joint under general anesthesia. The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Results: Patients were evaluated clinical y and radiographical y at the time of presentation, im-mediately postoperatively, and at the time of the latest fol ow-up. Al patients were available for clinical and radiographic fol ow-up averaging 22 months (range 16~34months) from the time of surgery. The postoperative clinical scoring systerm by Adelaar was used for evaluation. there were two excellent , eleven good ,two fair and one poor results. One redislocation occurred and required subsequent extensive soft-tissue releases. Dorsal subluxation of the navicular recurred in two patients. Conclusions:Serial manipulation and cast immobilization fol owed by talonavicular pin fixation and percutaneous tenotomy of the Achil es tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographical y at a minimum sixteen months, in patients with congenital vertical talus, especial y in those patients who were under six months old with idiopathic congenital vertical talus.