脊椎裂后遗足踝畸形的临床分析

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida

目的 分析脊椎裂后遗足踝畸形的发病情况、临床特点、畸形类别与矫形治疗状况.方法 对我科1990年1月至2009年7月接受手术治疗脊椎裂后遗足踝部畸形患者进行回顾性研究,对资料进行总结分析.结果 手术治疗脊椎裂后遗足踝部畸形共107例患者.其中男性44例,女性63例;手术年龄1.3～52.0岁,平均17.7岁,其中18岁以上者50.5%（54/107）.隐性脊椎裂50.5%（54/107）,显性（囊性）脊椎裂49.5%（53/107）.1例为胸椎裂（T3～8）,余106例为腰骶椎裂.单侧足受累49例（左侧22例,右侧27例）,双侧足受累58例,共165足.畸形类型：内翻足76足,外翻足23足,夏科连枷足15足,其他类足畸形51足.合并其他受累部位：膝部屈曲或膝反屈畸形4例,髋部畸形17例（包括髋内收、屈曲或髋关节脱位,骨盆倾斜、双下肢不等长等）,合并大小便功能障碍30例.本组54例隐性脊椎裂致足踝畸形患者中,29例既往在多个医院未能确诊发病原因,误诊或漏诊的比率高达53.7%（29/54）.107例患者中,既往接受过足踝畸形矫形手术者仅26例.18岁以上既往未能实施合理矫形外科治疗遗留严重足踝畸形者50.5%（54/107）.结论 脊椎裂继发畸形主要在足踝部.由于缺乏对此病的整体认识与矫形治疗经验,延误了对此类疾病的早期诊断、早期干预的治疗时机,遗留了很多未经矫形外科治疗的严重足踝畸形.

Objective To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida. Methods The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed. Results One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years （ range, 1.3 -52. 0 years）. And 50.5 % （ 54/107 ） of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida （T3-8 ）, while the other 106 cases had lumbosacral vertebrae cleft （mainly L3 to Sacrum）. Among a total of 165 feet, unilateral involvement was found in 49 cases （22 cases on the left side, 27 cases on the right side）, bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus tslipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity （hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc. ） in 17cases,and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% （29/54）.Corrective surgery was performed in only 26 patients. And 50.5 % （54/107） of patients （over 18 years old）had severe foot and ankle deformities due to a failure of prior surgical treatment. Conclusions Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle.Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-speciality of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.