Ilizarov技术矫治成人下肢外伤后遗足踝部马蹄畸形

Ilizarov technique in correction of posttraumatic equinus deformity in adults

目的探讨应用Ilizarov技术结合软组织松解,有限截骨,关节融合矫治成年人下肢外伤后足踝部马蹄畸形的临床问题。方法 2009年6月-2012年2月,遵循Ilizarov张力-应力法则及组织牵伸技术,治疗18例成人下肢外伤后遗足踝部马蹄畸形患者。其中马蹄内翻足13例,高弓马蹄足5例。术前周密分析致畸伤情、足踝部畸形状态,选择适度的软组织松解,肌腱延长,有限截骨或关节融合术,部分矫正足踝部畸形,再组装个体化足踝部Ilizarov牵伸矫形器,残留的畸形通过缓慢牵伸逐渐矫正。结果 18例患者随访8个月~3年,平均16个月,足踝部马蹄畸形,负重力线,足部应力分布获得完全或大部矫正,行走步态及负重功能恢复满意。踝关节活动度部分有一定改善。1例针道感染,1例轻度复发,马蹄畸形15°。根据国际马蹄足畸形研究学组（ICFSG）的评分系统：优3足,良11足,可4足,差0足。结论应用Ilizarov技术矫治成年人下肢外伤后足踝部马蹄畸形,根据个体畸形情况,有针对性选择软组织松解,有限截骨或关节融合术,有助于外固定器的准确安装,减少牵伸张力及时间,最大程度矫正畸形,有效地预防畸形复发。

【Objective】To investigate the clinical efficacy of Ilizarov technique in correction of the post-traumatic stiff equinus deformity in adults by soft tissue release combined with limited osteotomy and arthrodesis. 【Methods】Between June 2009 and February 2012, 18 club feet of 18 patients in post-traumatic lower extremities were corrected using Ilizarov tissue distraction technique combined with conventional surgical treatments. Among the 18 feet, 13 feet were talipes equinovarus and 5 were equinocavovarus. The operative procedures of limited soft tissue release and tendon transfer/lengthening, osteotomy and arthrodesis were selected according to the deformity of the foot, for partially correcting the foot deformity and installing the frames conveniently. Special distraction apparatus of the foot-ankle was designed according to the talipedic deformity appearance. Gradual and slow tissue distraction was applied until the deformities were completely corrected. The fixation of ankle-foot orthosis was applied on all the patients to prevent late recurrence of the deformities. 【Results】All patients＇ clubfeet were completely corrected over treatment. Finally, 18 patients were followed up for an average duration of 16 months（ranging 8 ~36 months）. One case had pin tract infection. One feet suffered from mild recurrent deformity with equinus 15°. Some patients obtained a more mobile foot. The final outcome was assessed using the International Clubfoot Study Group（ICFSG）score： 3 feet were excellent, 11 were good, 4 were fair and no poor. 【Conclusions】Ilizarov soft tissue release distraction combined with limited osteotomy and arthrodesis allows installation of external fixators and a greater degree of correction of equinus deformity in the adult post-traumatic lower extremities. Moreover, callotasis of tarsal bone allows decrease of recurrent deformity.