三关节融合法治疗小儿马蹄内翻足40例疗效分析

Effect analysis of 40 cases of pediatric talipes equinovarus treated with three joint fusion

目的观察三关节融合＋跟腱延长＋跖筋膜切断的手术方法治疗马达加斯加共和国（以下简称马国）小儿先天性马蹄内翻足的临床疗效。方法40例（60足）患儿采用三关节融合＋跟腱延长＋跖筋膜切断的手术方法治疗，术后长腿管形石膏固定足踝部于矫正位、膝关节屈曲30°，抬高患足，密切观察患肢血液循环，12～14d拆线，6周后拔除克氏针，更换短腿管形石膏固定，逐渐练习关节活动，带管形石膏下地功能锻炼。术后进行疗效评价，术前及末次随访分别测量足跖屈角度、背屈角度及侧位X线片距跟角度。结果术后40例患儿获得随访，随访时间8月至2年，平均16月，畸形矫正满意，未见复发，足负重行走功能良好。其中优34足，良15足，可11足，优良率达81．7％；术后末次随访时跖屈角度与术前比较，差异具有统计意义（P〈0．05）；术后末次随访时背屈角度及侧位距跟角度与术前比较，差异具有高度统计意义（P〈0．01）。结论施行三关节融合＋跟腱延长＋跖筋膜切断术方法治疗小儿先天性马蹄内翻足，只要手术操作过程准确得当，术后矫形处置得当，可以获得满意的疗效；在马国这种一次性手术是治疗小儿先天性马蹄内翻足的一种有效方法。

Objective To observe the clinic effect of three joint fusion ＋ Achilles tendon lengthening ＋ plantar fascia cut treatment of children with congenital talipes equinovarus in Republic of Madagascar. Methods 40 cases （60 feet ） were treated by three joint fusion＋Achilles tendon lengthening ＋ plantar fascia cut treatment, postoperative long leg plaster ankle was used to fix the leg in correct position, knee flexion 30°, raising the affected foot, close observation of blood circulation of the problem limb, 12 - 14 d removal of the thread, 6 weeks removal Kirschner, replacing with the short leg plaster, gradually exercise joint activities, with a pipe plaster to functional exercise. The therapeutic effect was evaluated after surgery, before surgery and at the last follow-up foot plantar flexion, dorsiflexion angle and lateral radiographs of talocalcaneal angle were measured. Results 40 cases were followed up, following up time was from 8 months to 2 years long, averaging 16 months. Deformity was corrected satisfactorily, with no recurrence, good foot weight-bearing walking function. There were 34 feet in excellent position , 15 feet in good place, 11 feet feasible, The excellent and good rate was 81.7% ; postoperative plantar flexion angle at the last follow-up had statistical difference with preoperation （ P〈0.05 ） ; after the time of last follow-up, dorsiflexion angle and lateral distance compared with the angles in the preoperation was highly statistically significant（ P〈0.01 ）. Conclusion Three joint fusion＋Achilles tendon lengthening ＋ plantar fascia resection method for the treatment of congenital talipes equinovarus in children, as long as the operation process is accurately and appropriately, postoperative orthopedic dispose is proper, can obtain curative effect, make the patient satisfactory; inMadagascar this one-time operation is an effective method for treating children with congenital talipes equinovarus.