Mckay术及其改良治疗多关节挛缩症马蹄内翻足

Mckay and modified Mckay procedure treatment for equinovarus deformity of arthrogryposis multiplex congenita

目的探讨Mckay手术及其改良治疗小儿先天性多关节挛缩症的马蹄内翻足畸形的临床应用及疗效。方法1998～2005年间采用Mckay术及其改良治疗先天性多关节挛缩症中马蹄内翻足畸形13例(共24足),术中采用Mckay术内后外长U形切口7例(14足)或改良后之跟腱外侧弧形/直切口加内侧弧性切口6例(10足),加大后内侧松解范围,充分延长跟腱和屈拇长肌腱,胫前肌腱部分切断,以克氏针固定距下关节,术后石膏固定6～8周。结果随访1～5年,平均3.3年,根据术后足的外观形态、足印、踝部功能、有无疼痛及X线检查进行评价:优6例11足;良3例6足;可4例7足,优良率70.8%。结论多关节挛缩症病因不清,伴发畸形多且重,其马蹄畸形的矫治较为困难,疗效多不理想。Mckay术及其改良是矫正小儿僵硬型先天性马蹄内翻足的有效手术方法,其优点是纠正彻底、手术时间短而矫形效果好,伤口愈合可,恢复时间快,同样可用于多关节挛缩症之马蹄畸形的矫治,但疗效较先天性马蹄内翻足稍差。

Objective To discuss Mckay and modified Mckay procedure＇s clinical application and curative effect for the treat ment of equinovarus deformity in arthrogryposis multiplex congenita in children. Methods From 1998 to 2005, 13 cases（24 feet） were treated by Mckay and modified Mckay procedure. Through enlarging medial solution, sufficient extending achilles tendon and hallux longus tendon, cutting partial anterior tibial muscle tendon, fixing talocalcaneal joint by Kirschner wire, Cypsu fibrosum fixing 6 to 8 weeks, the cincinnati cut were adopted in 7cases（14 feet）,6 cases（10 feet） were operated by modified Mckay procedure. Results All the patients were followed up for 1 5 years, average 3.3 years. According to postoperative foot appearance, podogram, ankle＇s function, pain, the evaluation was made, 6 cases（11 feet ） were excellent, 3 cases（6 feet） were good, 4 cases （7 feet） were common, the rate of fine 70.8%. Conclusion There is no understanding of origin of the disease of arthrogryposis multiplex congenita. There are severely multiple deformity. Mckay and modified Mckay procedure are effective operation to correct stiff clubfoot, with the merits of thorough rectification, less short operation time and excellent effect as well as good intention and more fast recovery. But in comparison with the curative effect of arthrogryposis multiplex congenita and congenita talipes equino varus, the latter is better.