摘要
目的探讨Ilizarov技术联合Ponseti方法治疗大龄儿童僵硬性马蹄内翻足畸形的临床疗效。方法回顾性分析2012年7月至2016年7月玉林桂南医院收治的36例(49足)儿童僵硬性马蹄内翻足病例的临床资料,术前均行负重位踝关节正侧位X线检查,根据安装Ilizarov外固定架治疗前是否进行Ponseti石膏矫正分为A组(未进行Ponseti石膏矫正)和B组(进行Ponseti石膏矫正)。A组18例(24足),男13例,女5例,年龄为(9.5±2.3)岁(6~14岁)。B组18例(25足),男12例,女6例,年龄为(9.8±2.1)岁(6~15岁)。A组患儿直接安装Ilizarov外固定架治疗,B组患儿予Ponseti系列石膏矫正4~10次后行经皮跟腱松解术,然后安装Ilizarov外固定架治疗。两组患儿术后均佩戴足踝矫形器固定8~10周。两组患儿术后随访时行负重下踝关节正侧位X线片检查,测量并记录胫距角变化。采用国际马蹄内翻足研究会评定标准(ICFSG)评价术后疗效。记录并比较两组病人马蹄足畸形矫正时间、佩戴外固定架时间。结果患儿平均随访时间为58个月(36~75个月)。术后2年随访,两组胫距角比较,差异有统计学意义(t=2.468,P=0.017)。A组24足,ICFSG评分优11足、良5足、可4足、差4足,优良率为66.7%;B组25足,优20足、良1足、可4足,优良率为84.0%,两组优良率的差异有统计学意义(χ^(2)=8.667,P=0.034)。B组马蹄足畸形矫正时间、佩戴外固定架时间均小于A组,差异均有统计学意义(P均<0.05)。A组有2例出现皮肤坏死,3例血管神经损伤,2例钉道感染;B组无相关并发症。结论应用Ilizarov技术联合Pon⁃seti方法治疗儿童僵硬性马蹄内翻足可取得良好疗效,矫形效果满意,能最大程度保留足的外形和功能,值得临床推广。
Objective To evaluate the clinical results of Illizarov technique combined with Ponseti method for the treatment of the rigid equinovarus deformity.Methods From July 2012 to July 2016,36 patients(49 feet)with rigid talipes equinovarus deformities which had been corrected with Illizarov technique combined with Ponseti method in Guinan Hospital of Yulin were retrospectively analyzed.All patients took the weight⁃bearing ankle radiographs pre⁃operatively.The group A was treated with Illizarov technique directly while group B with Ponseti method before Illizarov technique.In group A,there were 13 boys and 5 girls with an age of(9.5±2.3)years(6⁃14 years).In group B,there were 12 boys and 6 girls with an age of(9.8±2.1)years(6⁃15 years).Both groups were treated with ankle⁃foot orthosis for 8⁃10 weeks postoperatively.The changes of tibiotalar angle were measured and recorded.The excellent and good rate of operation was evaluated by the International Clubfoot Study Group(ICFSG)scoring system.The correction time and the time of wearing external fixator were recorded and compared between the two groups.Results The mean follow⁃up time was 58 months(36⁃75 months).After follow⁃up of 2 years,the talocrural angle between two groups showed a great difference(t=2.468,P=0.017).In group A,ICFSG score was excellent in 11 feet,good in 5 feet,fair in 4 feet and poor in 4 feet,with the excellent and good rate of 66.7%;In group B,25 feet were excellent in 20 feet,good in 1 foot and fair in 4 feet,and the excellent and good rate was 84.0%.The difference between the two groups was statistically significant(χ^(2)=8.667,P=0.034).The correction time and the time of wearing external fixator in group B were significantly shorter than those in group A(P<0.05).In group A,there were 2 cases of skin necrosis,3 cases of vascular nerve injury and 2 cases of nail infection.There were no complications in group B.Conclusion Ilizarov technique combined with Ponseti method in the treatment of children with rigid clubfoot can achieve good curative effect,and can retain the shape and function of the foot to the greatest extent.The orthopedic effect is satisfactory,which is worthy of clinical promotion.
作者
廖喜
周德勇
陈述
燕华
史强
LIAO Xi;ZHOU De-yong;CHEN Shu;YAN Hua;SHI Qiang(Department of Orthopaedics,Guinan Hospital of Yulin,Yulin 537000,China;Department of Pediatric Orthopaedics,Guangzhou Huaxin Orthopaedic Hospital,Guangzhou 510507,China;Department of Spine Surgery,Changsha Central Hospital,University of South China,Changsha 410008,China)
出处
《骨科》
CAS
2021年第3期206-210,共5页
ORTHOPAEDICS
