熏洗按摩手法矫形“L”形支具治疗小儿先天性马蹄内翻足

Treatment by fumigation-washing combined with massage and splint of“L-shaped ”for congenital clubfoot in infant

目的：探讨熏洗按摩手法矫形“L”形支具治疗小儿先天性马蹄内翻足的方法及疗效。方法2010年2月至2014年3月我们收治首诊年龄小于100 d的先天性马蹄内翻足患儿92例（134足），均先由患儿家长运用熏洗按摩进行手法矫形，待僵硬的马蹄畸形变得松弛后再予“L”形支具固定，在支具固定期每天定时松脱支具进行熏洗按摩。定期随访和进行疗效评定。结果本组32例50足完成了治疗（7例11足作了跟腱延长术）并获得1年以上随访（平均1年9个月）。疗效按Dimeglio评分系统进行，42足达Ⅰ级，8足达Ⅱ级标准。14例单侧患儿瘦小的患侧小腿明显丰满起来，1例大于健侧0．5cm，7例两侧已无差异。仍比健侧小1．0cm、0．6cm和0．4cm者各2例。结论熏洗按摩手法矫形“L”形支具治疗小儿先天性马蹄内翻足，与当前流行的Ponseti技术比较，无需石膏固定，畸形矫正效果好，小腿丰满，足的柔韧性好，行走无疼痛，医疗费用低。

Objetive To introduce our treatment program and result by fumigation with“shujin houxue”decoction combined with massage and orthotics for congenital clubfoot of infants.The treatment applied dialy at a reqular time by the patientsparants consisted of fumigation and massage with“shujin huoxue”Chinese traditional medicine decoction,as well as usage of an orthotic“L-shaped splint”. Methods From February 2010 to March 2014,we treated 92 infants （134 feet）with congenital clubfoot by our program and evaluated progress. All patients were under 100 days of age when the treatment began. Results We followed 32 patients （50 clubfeet）for an average period of 21months（minimum 12 months）.Lengthening of the achilles tendon was performed on only 11of these clubfeet.The effect of the treatment was evaluated using the Dimeglio scoring system.The deformity rectification effects were satisfying and easily visible in all patients. Conclusion Greater efficacy was found in our treatment program compared to the Ponseti method.The advantage of our treatment program was obvious,becouse it does not require plaster cast fixation,only a combination of“shujin huoxue ”decoction and massage.Consequently there is no muscle atrophy,no stiffness of jionts,no range pain,and the foot will grow more normally and keep its pliability.Also The medical expenses are much lower.