Ilizarov外固定架治疗大龄儿童马蹄内翻足的效果分析

Treatment of clubfoot in older children with Ilizarov external fixator

目的：探索大龄儿童（6岁及以上）马蹄内翻足的治疗方法及效果。方法：将我院骨科收治大龄马蹄内翻足患儿46例（56足）,单侧马蹄内翻足36例,双侧马蹄内翻足10例。按照病因分为先天性马蹄内翻足（A组）和外伤性马蹄内翻足（B组）,其中A组31例（41足）,B组15例（15足）。按ICFSG评分标准,从形态学（12分）、功能（36分）、影像学（12分）三个方面评分,从正常的0分到畸形最严重的60分,优0~5分,良6~15分,中16~30分,差31~60分。术前对56只足评分,优0足,良0足,中17足（A组11足,B组6足）,差39足（A组30足,B组9足）。46例患儿均采用Ilizarov外固定架矫正畸形,并根据患儿的年龄、足畸形的程度和性质及有无严重的骨性畸形改变,结合软组织松解、跟腱延长、距舟关节或骰骨V形截骨等有限的手术方式治疗。结果：本组46例（56足）均获得随访,随访时间9个月~4年,按ICFSG评分标准评价疗效,优40足（A组30足,B组10足）,良11足（A组8足,B组3足）,中5足（A组3足,B组2足）,差0足,疗效优良。3例发生针道反应,无残余畸形发生。两组治疗优良率差异无统计学意义（P〉0.05）。结论：大龄儿童（6岁及以上）马蹄内翻足,就诊时间晚,畸形重,采用传统手术矫正畸形,治疗效果不佳且容易复发,采用Ilizarov外固定架治疗大龄儿童马蹄内翻足具有手术创伤小、安全、畸形矫正效果满意、踝关节功能良好且不易复发等优点,不失为治疗大龄儿童马蹄内翻足畸形的优先选择。

Objective：To study the method and effect of treatment of clubfoot in older children（above 6 years old）.Methods：46 patients（56 feet） with clubfoot,including 26 males and 20 females,were treated in our hospital from June 2006 to June 2010.Among these patients,there were 36 unilateral and 10 bilateral deformities.The patients aged 6-16 years.According to the etiopathogenisis,all patients were divided into congenital group（group A,31 cases,41 feet） and traumatic group（group B,15 cases,15 feet）.All the feet were evaluated by ICFSG scoring system,including morphology（12 points）,functional evaluation（36 points） and radiological evaluation（12 points）,from the normal to the most serious abnormal 0~60 points,excellent 0-5 points,good 6-15 points,general 16-30 points and poor 31-60 points.Preoperative scores of 56 feet were marked： excellent 0,good 0,general 17 feet（11 feet in group A and 6 feet in group B） and poor 39 feet（30 feet in group A and 9 feet in group B）.According to the patient＇s age,degree and nature of deformity and with or without severe bone deformity,46 cases were all treated with Ilizarov external fixators combined with limited operation such as soft tissue release,Achills tendon extension and V-shaped osteotomies of the talonavicular joint or cuboid bone.Results：All the 46 cases（56 feet） were followed up from 9 months to 4 years.The results were assessed using ICFSG scoring system,excellent in 40 feet（30 feet in group A and 10 feet in group B）,good in11 feet（8 feet in group A and 3 feet in group B）,general in 5 feet（3 feet in group A and 2 feet in group B） and poor 0.The effect was excellent.3 cases had pin hole reaction and no residual deformity occurred.The excellent rate was analyzed with SPSS17.0 and the result showed no significant differences between the two groups（P0.05）.Conclusion：Because of delayed treatment and severe deformity,the older children（6 years old and above） treated with traditional operation would have poor effects and be easy to relapse.Treating clubfoot in older children with the Ilizarov external fixator is minimally invasive,secure and difficult to relapse with satisfactory correction of deformity and good function of the ankle joint,which is a good choice to treat clubfoot in older children.