Ilizarov外固定支架牵伸微创治疗瘢痕性足踝部畸形

The llizarov minimally invasive technique for treatment of cicatricial deformity of the foot and ankle

目的探讨Ilizarov外固定支架牵伸微创治疗瘢痕性足踝部畸形的疗效。方法回顾性分析2004年1月至2012年2月采用Ilizarov外固定支架牵伸微创治疗且获完整随访的15例瘢痕性足踝部畸形患者资料，均为男性；年龄24～56岁，平均38．5岁；左侧6例，右侧9例。均为僵硬型瘢痕挛缩足踝部挛缩畸形。4例跟行足样背屈畸形患者背屈范围为20°-30°，平均24．3°；11例马蹄足样跖屈畸形患者跖屈范围为20°-50°，平均30．2°。个体化设计、组装Ilizarov外固定支架牵伸器，5例结合有限软组织松解术，3例行踝关节融合术。术后牵伸速度≤1mm／d，分4—6次完成。足踝部畸形完全矫正后保留外固定支架6～8周。结果15例患者术后获8个月至6年（平均28．0个月）随访。15例患者足踝部畸形矫正后达到踝关节中立位（0°位），较术前平均改善29．4°，踝关节活动范围平均为15．1°。无神经、血管损伤等严重并发症发生，行走功能明显改善。2例患者足踝部畸形完全矫正后部分复发。3例患者踝关节融合术后获骨性愈合。按美国足与踝关节协会踝与后足功能评分标准评定疗效：优5例，良8例，可1例，差1例。结论利用Ilizarov外固定支架牵伸微创治疗瘢痕性足踝部畸形，不仅能够有效矫正足踝部复杂、多样畸形，而且可避免切开松解延长术后出现的瘢痕皮肤缺损、坏死、伤口不愈合及感染等问题。

Objective To explore clinical efficacy of the Ilizarov minimally invasive technique in the treatment of cicatricial deformity of the foot and ankle. Methods From January 2004 to February 2012, the Ilizarov minimally invasive technique was used to treat 15 male patients with cicatricial deformity of the foot and ankle. They were aged from 24 to 56 years （average, 38.5 years）. The left side was affected in 6 and the right side in 9 cases. In the 4 patients with paralytic talipes calcaneus and dorsiflexion deformity of cicatricial contracture, the dorsiflexion ranged from 20° to 30° （average, 24. 3°）. In the 11 patients with talipes equinus and plantar flexion deformity of cicatricial contracture, the plantar flexion ranged from 20° to 50° （average, 30. 2°）. The llizarov external fixators designed individually were installed in the operation. Limited release of the soft tissue was performed in 5 patients and minimally invasive ankle fusion in 3. The telescopic rods on the Ilizarov external fixators were rotated 4 to 6 times per day with a speed of less than 1 mm according to the condition of local soft tissue and the patient＇s tolerance. After the deformity was corrected, the Ilizarov external fixators were maintained for 6 to 8 weeks. Results All patients were followed up from 8 months to 6 years （average, 28.0 months） . All the deformities were corrected to the neutral position of the ankle, and the average postoperative improvement reached 29.4° so that the range of motion of the ankle joint averaged 15. 1 ° without neurovascular injury or other severe complications. Two patients lost part of the thorough correction they obtained postoperation and hone healing was achieved in 3 patients after ankle fusion. According to the American Orthopaedic Foot ＆ Ankle Society （AOFAS） evaluation system, 5 patients were rated as excellent, 8 as good, one as fair and one as poor. Conclusion The complicated and diverse deformities of the foot and ankle can be corrected effectively by the Ilizarov minimally invasive technique because complications due to open release and lengthening surgery can be avoided, such as cicatricial defect of the skin, skin necrosis and the non-healing wounds.