改良Ilizarov技术结合有限手术矫正马蹄内翻足畸形

Improved Ilizarov technique with limited operation for correction of talipes equinovarus

[目的]探讨Ilizarov技术矫正马蹄内翻足畸形的手术方法及器械改良、术后管理方法的改进及疗效。[方法]2003年1月～2006年5月，根据Ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循Ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准。在矫形的过程中定期进行X线检测，以防止发生踝关节前后移位，治疗期间允许患足负重行走。术后平均牵伸42d，拆外固定器后患足再上石膏固定适当时间。[结论]32例患者术后均获得随访，其中26例为来院复查。随访时间1年～3年1个月，平均1年5个月。畸形均获满意矫正，足持重行走功能良好，患者满意。本组无1例发生严重针道感染和切口感染，未并发踝关节脱位及血管、神经损伤等并发症。[结论]改良Ilizarov技术矫正马蹄内翻足畸形，手术创伤小、安全，治疗效果提高，配合有限矫形手术，能够矫正传统矫形手术难以治疗的严重足畸形，缩短治疗周期，避免了严重手术并发症。

[ Objective ] To explore the clinical efficiency, operative methods, apparatus assembly and postoperative administration of Ilizarov technique in the correction of talipes equinovarus. [Method] From January 2003 to May 2006, 32 patients were corrected with QIN Si-he＇s orthotics devices on the Ilizarov principle of tension-stress, which involved 15 males and 17 females, the age ranged from 10 to 25 years. Among these patients, 2 were caused by peroneal nerve injury, 1 by tumor in the vertebral canal, 5 by meningocele, 11 were caused by poliomyelitis, 13 by congenital talipes equino-varus. In accordance with deformities, external fixator and limitied operative methods were dertermined. The limited release of soft tissue were performed in 7 patients, limited osteotomy in 25 patients. The dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength. According to the Ilizarov technique, the fixative rods were installed. The telescopic rods on the apparatus were rotated one week after the operation, the divices had corrective function in three-dimensional directions. The deformity of talipes equinovarus, internal rotation and drooping of the forefoot were gradually corrected, and the patients could bear weight and walked on the deformed foot. The mean duration of traction were 42 days, then removed the external fixator maintained with plaster for a site time. [ Result ] All patients were followed up from 12 months to 37 months with an average of 17 months. There was no recurrence of the deformity and feet function was good while walking on full weight-bearing. None of the complication occurred postoperatively sush as infection in the incision, neurovascular injury and ankle dislocation. [ Conclusion] With Ilizarov technique to correct talipes equinovarus is a safe, minimally invasive and effective method. Combined with limited operation Ilizarov technique can correct severe talipes equinovarus which is unattainable by traditional orthopedic surgery, and shorten the treatment period, avoid severe complications.