脊髓神经源性足部畸形的分类和治疗

Classification and surgical treatment of spinal neurogenic foot deformity

[目的]研究脊髓神经源性足部畸形的发病机理、分类和手术治疗方案。[方法]1988年10月～2006年6月,回顾性分析脊髓病变、脊髓和脊神经因被牵拉或压迫引起的足部畸形167例258足,根据脊髓损伤的性质和发病机理,将足部畸形分为上运动神经元损伤型和下运动神经元损伤型两大类,两类足部畸形采用不同的治疗方案。上运动神经元损伤型足部畸形,手术方案以选择性脊神经后根切断术或周围神经缩窄术为主;下运动神经元损伤型足部畸形,手术方案以软组织松解、肌腱转位术和截骨术为主,其中僵硬性足部畸形使用Ilizarov外固定器缓慢矫正。[结果]得到至少5年随访的147例228足进行总结分析,上运动神经元损伤型足部畸形42足,下运动神经元损伤型足部畸形186足。采用Laaveg-Ponseti足功能评分系统:优94足,良84足,可32足,差18足;优良率78.1%。第1次术后复发36足,复发率15.8%。第2次术后复发8足。[结论]根据脊髓神经源性足部畸形的分类,采用不同的手术治疗方案,可提高治疗效果,减少术后畸形复发。

[Objective]To study the pathogenesis,classification and surgical treatment of spinal neurogenic foot deformity.[Methods]From October 1988 to June 2006,167 cases（258 feet） treated with operation were statistically analysed retrospectively.The pathogenesis were spinal cord disease,with pulled and oppressed spinal cord or spinal nerves.Accoding to the characteristic and pathogenesis,the foot deformity was divided into two groups：the type of upper motor neurons injury and the type of lower motor neurons injury.Different operative methods were adopted to two different types.Foot deformity in the type of upper motor neurons injury were mainly treated with functionally selective posterior rhizotomy or tibial neurotomy.Foot deformity in the type of lower motor neurons injury were mainly treated with soft tissue release,transformation of tendon and osteotomy.Ilizarov external fixator was used to correct stiff foot deformity slowly.[Results]Totally 228 feet in 147 patients were followed up for at least 5 years and were generally analyzed.Foot deformity in the type of upper motor neurons injury were 42 feet.Foot deformity in the type of lower motor neurons injury were 186 feet.Clinical outcomes were evaluated according to Laaveg-Ponseti foot score.Excellent result was found in 94 feet,good in 84 feet,fair in 32 feet and poor in 18 feet.The rate of excellent and good results were 78.1%.Relapse cases after first operation were 36 feet and the reoccurrence rate was 15.8%.Relapse cases after second operation were 8 feet.[Conclusion]Applying the classification of spinal neurogenic foot deformity,different surgical treatments may be taken.It can increase curative effect and decrease recurrence of the foot deformity.