Ilizarov外固定架治疗重度马蹄内翻足畸形243例疗效分析

Treatment of 243 patients with severe degree clubfoot in adolescents with Ilizarov technique and limited external fixator methods

目的探讨Ilizarov外固定架治疗重度马蹄内翻足畸形临床效果,为重度马蹄内翻足畸形的治疗提供依据。方法对清华大学玉泉医院2010年1月至2014年1月收治的重度僵硬型马蹄内翻足畸形患者243例（270足）的临床资料进行回顾性分析,所有患者均采用Ilizarov外固定架治疗,观察其治疗后的临床效果及安全性。结果所有患者均获得6个月以上随访,术后6-8周踝关节恢复到中立位。平均带外固定架12周（10-14周）。243例患者中优176足,良70足,差24足,优良率达91%;其中先天性马蹄内翻足优116足,良45足;其他类型马蹄内翻足优60足,良25足,两种类型治疗后优良率相比,差异无显著性（P〉0.05）;243例患者治疗后国际马蹄足畸形研究会（Indian Club Foot Study Group,ICFSG）评分为（36.72±8.63）分,显著高于治疗后的（6.59±4.25）分,患者治疗前后ICFSG评分相比,差异有显著性（t=6.047,P〈0.05）。治疗期间仅发生轻度针道口感染9例（11足）占4.07%,经对症治疗后痊愈;所有病例未发生重度马蹄内翻足的复发,未发生过度矫正或神经血管牵拉伤等。结论采用Ilizarov外固定架治疗重度马蹄内翻足具有手术创伤小、安全、畸形矫正效果满意、踝关节功能良好且不易复发等优点,值得临床推广。

Objective To explore the clinical effect of Ilizarov technique combined with external fixator in treatment of severe degree clubfoot in adolescents. It could provide a better way to treat the clubfoot. Method 243 patients with severe clubfoot from January 2010 to January 2014 in our hospital were to be studied. All patients were treated with Ilizarov external fixation for the treatment, and the clinical effect and safety of the after treatment would be observed. Result All the patients were followed up for 6 months after 6 to 8 weeks of recovery of ankle joint in neutral. Fixed at an average of 12 weeks （10 -14 weeks）. In 243 patients,176 cases were excellent, 70 good, 24 poor enough, the excellent and good rate was 91%; in congenital talipes equinovarus excellent 116, good 45 feet;the other talipes equinovarus was excellent in 60 cases, good in 25 feet, good rate of two types of treatment was compared after no significant difference（P〉0. 05）;243 of the patients after treatment,ICFSG score of （36. 72±8. 63）, after treatment was significantly higher than that of （6. 59±4. 25）, compared to the ICFSG scores of the patients before and after treatment, there was statistically significant difference in t=6. 047,P〈0. 05; occurred during the treatment period 9 cases of mild needle cross infection （11 feet） accounted for 4. 07%, after symptomatic treatment all patients were cured;wound infection did not occur, the displacement of the ankle joint, blood vessel or nerve injury, the occurrence of excessive correction. Conclusion With Ilizarov external fixator in the treatment of severe talipes equinovarus has the advantages of small operation wound, safety, deformity correction effect is satisfactory, ankle joint function is good and not easy to relapse and other advantages, is worth the clinical promotion.