CAJ | 학술논문

目的比较单纯Ilizarov技术与结合软组织松解治疗刨伤后重度足下垂畸形的疗效.方法 2006年10月至2011年12月收治26例创伤后继发性重度足下垂畸形患者,男15例,女11例；年龄14～53岁,平均33.0岁；左侧14例,右侧12例.12例患者采用单纯限制型Ilizarov外固定支架缓慢牵伸矫正(单纯组),14例患者采用软组织松解结合限制型外固定支架缓慢牵伸矫正(结合组).比较末次随访时两组患者的最大背伸位跖屈角、关节活动度、视觉模拟踝足评分量表(VAS-FA)评分和矫正丢失度等. 结果 26例患者术后获12～36个月(平均24.8个月)随访.单纯组与结合组患者平均最大背伸位跖屈角由术前的51.7°±6.2°、55.0°±7.3°分别矫正至末次随访时的-9.2°±8.7°、-11.4°±8.7°,平均关节活动度由术前的7.1 °±5.4°、6.4°±5.0°分别增加至末次随访时的25.8°±12.4°、26.4°±10.1°,平均VAS-FA评分由术前的(34.9±5.2)、(33.9±5.5)分增加至末次随访时的(86.6±6.3)、(88.8±4.0)分,同一组组内术前与末次随访时比较差异均有统计学意义(P＜0.05),而同一时间点两组间比较差异均无统计学意义(P＞0.05).两组患者的矫正丢失角度比较差异无统计学意义(P＞0.05).单纯组患者平均矫正时间和带架时间长于结合组,差异均有统计学意义(P＜0.05). 结论单纯Ilizarov技术或软组织松解结合Ilizarov技术均可安全、有效地矫正创伤后重度足下垂畸形,但软组织松解结合Ilizarov技术可显著缩短治疗周期.
목적 비교단순Ilizarov기술여결합연조직송해치료포상후중도족하수기형적료효.방법 2006년10월지2011년12월수치26례창상후계발성중도족하수기형환자,남15례,녀11례；년령14～53세,평균33.0세；좌측14례,우측12례.12례환자채용단순한제형Ilizarov외고정지가완만견신교정(단순조),14례환자채용연조직송해결합한제형외고정지가완만견신교정(결합조).비교말차수방시량조환자적최대배신위척굴각、관절활동도、시각모의과족평분량표(VAS-FA)평분화교정주실도등. 결과 26례환자술후획12～36개월(평균24.8개월)수방.단순조여결합조환자평균최대배신위척굴각유술전적51.7°±6.2°、55.0°±7.3°분별교정지말차수방시적-9.2°±8.7°、-11.4°±8.7°,평균관절활동도유술전적7.1 °±5.4°、6.4°±5.0°분별증가지말차수방시적25.8°±12.4°、26.4°±10.1°,평균VAS-FA평분유술전적(34.9±5.2)、(33.9±5.5)분증가지말차수방시적(86.6±6.3)、(88.8±4.0)분,동일조조내술전여말차수방시비교차이균유통계학의의(P＜0.05),이동일시간점량조간비교차이균무통계학의의(P＞0.05).량조환자적교정주실각도비교차이무통계학의의(P＞0.05).단순조환자평균교정시간화대가시간장우결합조,차이균유통계학의의(P＜0.05). 결론 단순Ilizarov기술혹연조직송해결합Ilizarov기술균가안전、유효지교정창상후중도족하수기형,단연조직송해결합Ilizarov기술가현저축단치료주기.
Objective To compare clinical outcomes of simple Ilizarov technique versus Ilizarov technique combined with soft tissue release in the treatment of posttraumatic equinus contracture.Methods From October 2006 to December 2011,26 patients who had suffered from unilateral rigid equinus contracture secondary to trauma were surgically treated in our department.They were 15 males and 11 females,aged 14 to 53 years (average,33.0 years).Of them,12 patients were treated by gradual distraction using simple Ilizarov technique (group A) while 14 patients were cured by Ilizarov technique combined with soft tissue release (group B).The 2 groups were compared in terms of plantar flexion at the maximal dorsiflexion,range of motion (ROM),Visual Analogue Scale Foot and Ankle (VAS-FA) score and correction loss at the last follow-ups.Results All the 26 patients were followed up from 12 to 36 months (average,24.8 months).The plantar flexion at the maximal dorsiflexion was respectively corrected from 51.7°± 6.2° in group A and 55.0° ± 7.3° in group B before operation to-9.2° ± 8.7° in group A and-11.4° ± 8.7° in group B at the latest follow up;ROM increased from 7.1 ° ± 5.4° in group A and 6.4° ± 5.0° in group B preoperatively to 25.8° ± 12.4° and 26.4° ± 10.1° respectively at the latest follow up;VAS-FA was improved from 34.9 ± 5.2 points in group A and 33.9 ± 5.5 points in group B preoperatively to 86.6 ± 6.3 points and 88.8 ± 4.0 points respectively at the last follow-up.There were significant differences between preoperation and the last follow-up within the same group (P ＜ 0.05),but no significant differences between groups at the same time point (P ＞ 0.05).Similarly,the correction loss was not significantly different between the 2 groups (P ＞0.05).The frame correction time and the total frame time in group A were significantly longer than those in group B (P ＜ 0.05).Conclusions Ilizarov technique is very safe and efficient in the treatment of rigid equinus contracture secondary to trauma.When combined with soft tissue release,this technique can significantly shorten the treatment cycle.