距骨穿针在Ilizarov技术矫正成人重度僵硬性马蹄内翻足畸形中的应用价值

Value of talus wiring in correction of severe rigid clubfoot deformity by Ilizarov method in adults

背景:Ilizarov技术治疗成人僵硬型马蹄内翻足疗效确切,已成为公认的治疗方法,目前的文献对Ilizarov技术的应用原则、手术适应证和禁忌证的研究较多,但对Ilizarov外固定器应用的技术细节探讨较少。目的:总结距骨穿针在Ilizarov技术矫正成人重度僵硬性马蹄内翻足畸形中的适应证和管理方法,探讨其应用价值。方法:回顾性分析2017年1月至2020年10月收治的22例(28足)成人重度僵硬性马蹄内翻足畸形患者的临床资料,男10例,女12例;年龄18~55岁,平均(35.5±10.2)岁;左足10例,右足6例,双足6例。28足均为僵硬性马蹄内翻足畸形,按秦氏马蹄内翻足畸形分度方法:Ⅱ度22足,Ⅲ度6足。在截骨基础上,应用Ilizarov技术牵伸矫正,距骨穿螺纹针,遵照"先矫正足内收、内翻畸形,再矫正跖屈畸形"的顺序矫正,定期调整距骨针的连接,直至畸形矫正。采用AOFAS足踝评分和秦泗河肢体残疾矫正评价标准进行评价。结果:22例患者全部获得随访,随访时间为6~36个月,平均(18.5±7.8)个月。所有畸形均获得矫正,足底负重行走,跛行步态较术前明显改变。2例(2足)足跟部发生针道感染,经换药和拔出克氏针后治愈。无局部皮肤坏死、肢端感觉麻木等并发症发生。3例畸形调整过程中发生胫距关节前脱位,改变外固定器构型后复位矫正。AOFAS足踝评分从术前平均(55.5±4.5)分提高至术后平均(81.5±6.5)分,差异有统计学意义(P=0.013)。秦泗河肢体残疾矫正评价标准进行评价,优17足、良7足、可4足,优良率为85.7%。结论:在Ilizarov技术矫正成人重度僵硬性马蹄内翻足畸形中,距骨穿针并适时调整,可有效预防距骨偏移的发生。

Background:Ilizarov method is effective for the treatment of rigid clubfoot in adult,which has become a recognized method.There are many studies on the application principles,surgical indications and contraindications of Ilizarov method,but few on technical details in the current literature.Objective:To investigate the indications and management methods of talus wiring in Ilizarov method in the correction of severe rigid clubfoot deformity in adults and its application value.Methods:From January 2017 to October 2020,22 patients(28 feet)with severe rigid clubfoot deformity were included in the study,including 10 males and 12 females,with the mean age of(35.5±10.2)years old(range,18-55),of 10 left feet,6 right feet and 6 both feet.All feet were rigid clubfoot deformity including 22 feet inⅡdegree and 6 feet inⅢdegree based on Qin classification.On the basis of osteotomy,Ilizarov method was applied.The talus was threaded through the wires or pins.The deformity was corrected according to the order of"varus and then equines".The connection of talus wire was adjusted regularly until the deformity was corrected.AOFAS score and Qinsihe lower limb deformity correction and disability evaluation table were used to evaluate the results.Results:All patients with severe rigid clubfoot deformity were followed up for 6-36 months with the mean of(18.5±7.8)months.All deformities were corrected.The patients walked with weight-bearing,and the lameness gait was significantly improved compared with that before operation.Two patients(two feet)with pin tract infection on heel were cured after changing and pulling out the Kirschner wire.There was no local skin necrosis or numbness of the extremities occurred.The dislocation of talar occurred in 3 cases of deformity correction,and after the external fixation configuration was changed,the talartibia joint was restored and the deformity was corrected.AOFAS score significantly increased from preoperative(55.5±4.5)points to postoperative(81.5±6.5)points(P=0.013).The results were excellent in 17 feet,good in 7 feet and acceptable in 4 feet with Qinsihe evaluation criteria,and the excellent and good rate was 85.7%.Conclusions:It is very important for severe rigid clubfoot deformity correction to use talus wiring and adjust in time,which can prevent the talus migration event.