CAJ | 학술논문

目的探讨先天性垂直距骨病例采用一期松解距骨周围复位联合胫前肌腱移位术的治疗方法.方法对2006年1月至2011年12月北京积水潭医院小儿骨科先天性垂直距骨病人21例35足采用一期充分软组织松解、距骨周围复位联合胫前肌腱移位至距骨颈进行治疗.男女比例2.5∶1,23％为单纯性垂直距骨,其余均合并有其他先天性或神经肌肉源性疾患.手术年龄12～48个月,平均30.1个月.手术采用相同术式完成,定期进行临床和X线观察,采用Kodros标准评价.X线参数的比较采用t检验.结果平均随访3.5(1.5～7)年.在全部35足中,优9％,良77％,可14％.所有患者家长均对足部外观和功能表示满意.均可穿正常鞋.结果为可的病例均合并多发关节挛缩症.未发现距骨缺血坏死,尚无病例需要再手术治疗.X线参数术后与术前相比有显著改善并获得正常(P＜0.05),末次随访与术后相比差异无统计学意义(P＞0.05).结论先天性垂直距骨多数合并有其他先天性或神经肌肉源性疾患.4岁之前采用一期充分软组织松解距骨周围复位联合胫前肌腱移位治疗能够获得满意疗效.
목적 탐토선천성수직거골병례채용일기송해거골주위복위연합경전기건이위술적치료방법.방법 대2006년1월지2011년12월북경적수담의원소인골과선천성수직거골병인21례35족채용일기충분연조직송해、거골주위복위연합경전기건이위지거골경진행치료.남녀비례2.5∶1,23％위단순성수직거골,기여균합병유기타선천성혹신경기육원성질환.수술년령12～48개월,평균30.1개월.수술채용상동술식완성,정기진행림상화X선관찰,채용Kodros표준평개.X선삼수적비교채용t검험.결과 평균수방3.5(1.5～7)년.재전부35족중,우9％,량77％,가14％.소유환자가장균대족부외관화공능표시만의.균가천정상혜.결과위가적병례균합병다발관절련축증.미발현거골결혈배사,상무병례수요재수술치료.X선삼수술후여술전상비유현저개선병획득정상(P＜0.05),말차수방여술후상비차이무통계학의의(P＞0.05).결론 선천성수직거골다수합병유기타선천성혹신경기육원성질환.4세지전채용일기충분연조직송해거골주위복위연합경전기건이위치료능구획득만의료효.
Objective To evaluate the surgical efficacies of one-stage comprehensive soft-tissue release and peritalar reduction incorporating tibialis anterior transfer (CSTR-PTR-TAT) in patients with congenital vertical talus (CVT) before the age of 4 years.Methods Thirty-five feet of 21 children with true congenital vertical talus were underwent one-stage CSTR-PTR-TAT.The male-to-female ratio was 2.5∶ 1.Twenty-three percent (5 patients with 8 feet) belonged to isolated CVT and the remaider CVT associated with other congenital or neuromuscular abnormalities.The mean operative age was 30.1 (12-48) months.All patients were available for clinical and radiological follow-ups for a mean period of 3.5 (1.5-7) years.Kodros scoring system was utilized for assessment of final outcomes.Results The outcomes of 3 feet (9％) were excellent,27 (77％) good and 5 (14％) fair.All patients wore normal shoes and were satisfied by their functional results and appearance.The patients with fair results were associated with arthrogryposis.No talar avascular necrosis was encountered.None required further operation.Radiologically there was a statistically significant postoperative improvement of measured angles compared to preoperative values (P ＜ 0.05).All radiological parameters were within normal ranges.There was no difference of posoperative angles compared to those at the final follow-up (P ＞ 0.05).Conclusion As a complex deformity usually associated with other congenital or neuromuscular abnormalities,CVT may be satisfactorily managed with one-stage correction by CSTR-PTR-TAT before the age of 4 years.