新微型足三维矫形外固定器治疗婴幼儿先天性马蹄内翻足

Novel external mini-frame for congenital talipes equinovarus in infants

背景:近年来,国内外开展应用Illizarov外固定器治疗成人马蹄内翻足,但由于Illizarov部件多、体积大、重量沉,无法应用于婴幼儿。目的:设计一种新微型足三维矫形外固定器,观察其治疗婴幼儿先天性马蹄内翻足效果。设计、时间及地点:回顾性分析2004-01/2007-06河北医科大学第三医院小儿骨科用自制新微型足三维矫形外固定器治疗婴幼儿先天性马蹄内翻足效果。对象:婴幼儿先天性马蹄内翻足106例(130足),男76例,女30例;年龄0.5～3岁,平均1.6岁。左侧80足,右侧50足;双侧24例,单侧82例;出生后经手法、支具、石膏矫形固定治疗未愈81例;在外院手术治疗10例畸形复发;未经治疗15例。新微型外固定器由作者自行设计,河北省衡水康达医疗器械生产厂生产。方法:根据年龄大小、畸形严重程度、首次或再次手术、足部病理变化,选择不同的治疗方法:①直接用新微型外固定器矫形固定。②有限软组织手术松解结合新微型外固定矫形固定。③扩大足内后侧软组织松解但不切开足部各关节囊,再用新微型矫形外固定器固定。④软组织松解、结合肌腱移位、肌力平衡,再用新微型外固定器矫形固定。术后固定时间3个月左右。主要观察指标:按Garceau临床疗效分级标准进行疗效评估。结果:随访时间0.5～3.5年,平均2.5年。足外形接近正常,行走时足底负重行走,足关节活动度好86例(94足);畸形明显减轻,但前足仍有轻度内收,足底负重行走,足各关节活动可17例(32足);前足轻度内收,跟骨轻度内翻,足跟内侧部分不着地行走,足各关节活动部分丧失3例(4足)。结论:新微型足三维矫形外固定器治疗婴幼儿先天性马蹄内翻足效果良好。

BACKGROUND： Recently, Illizarov external frame is commonly used to treat adult talipes equinovarus.However, its application is limited in infant and child due to amount of components, large volume and heavy weight. OBJECTIVE： A new three-dimensional external mini-frame was designed to observe its therapentical effects for congenital talipes equinovarus in infants. DESIGN, TIME AND SETTING： Retraspectively analysis of the therapentical effects of the three-dimensional external mini-frame for congenital talipes equinovarns in infants at the Department of Pediatric Orthopedics, Third Hospital of Hebei Medical University between January 2004 and June 2007. PARTICIPANTS： 106 infants （130 feet） with congenital talipes equinovarus, 76 males and 30 females aged 1.6 years （range 0.5-3 years）, including 80 left feet and 50 right feet, 24 cases bilateral feet and 82 cases unilateral feet. Eighty-one cases underwent orthosis or cost treatment but were not cured; 10 cases underwent surgery in other hospitals but all failed, the other cases were not given any treatment. The new three-dimensional external mini-frame was designed by the authors and produced by Hebei Hengshui Kangda. METHODS： According to the age, degree of deformity, being operated or not and pathological changes of the foot, different treatment methods were applied： Corrcetion and fixation of the foot directly with the new external mini-frame; Limited soft tissue release, followed by corrcetion and fixation of the foot with the mini-frame; Corrcetion and fixation of the foot with the mini-frame after more soft tissue realse on interior posterior foot; Corrcetion and fixation of the foot with the mini-frame after soft tissue release, tendon transfer and restore of muscle force balance. The postoperative external fixation lasted for about 3 mouths. MAIN OUTCOME MEASURES： Evaluatoin of therapentica! effects according to Garceau standards. RESULTS： All cases were followed up for 2.5 years （range 0.5-3.5 years）. Eighty-six cases （94 feet） were excellent： the foot looked near normal, the calcar pedis was erect, with plantigrade foot in walking, the range of the joint motion in foot was near normal. Seventeen cases （32 feet） were good： the foot deformity improved obviously, but a light adduction was remained in the forefoot, with plantigrade foot in walking, the range of joint motion in foot was good. Three cases （4 feet） were effective： the forefoot adduct lightly, with lightly calcaneus varus, the motion of foot was limitted partly. CONCLUSION： The new 3D external mini-frame shows favorable effects for congenital talipes equinovarns in infants.