分期治疗青少年儿童严重高弓马蹄内翻畸形

Staged Protocol for Severe Cavovarus Foot Deformity in Adolescents

目的探讨分期治疗青少年儿童严重高弓马蹄内翻畸形的方法和疗效。方法 2013-06/2015-06月,作者医院共收治12例严重高弓内翻足畸形青少年儿童。其中男8例,女4例;年龄7~17岁,平均11.3岁。所有患者均采用分期策略治疗,即Ⅰ期行经皮跟腱延长及软组织松解,并使用环形外固定支架进行性矫形,Ⅱ期待力线大致恢复后,择期行最终矫形手术。术后定期随访,摄片评估,并采用美国骨科足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)踝关节与后足功能评分系统及疼痛视觉模拟评分(visual analogue scale,VAS)法评定最终治疗效果,并记录相关并发症。结果本组患者两次手术均未见明显早期伤口感染、皮肤坏死等软组织并发症。本组共10例患者获最终随访,第二次术后平均随访时间21.5个月(10~34个月);Ⅱ期术后摄片明确平均12周(9~16周)骨性愈合。术后末次随访AOFAS踝后足功能评分和VAS均较术前明显改善。随访期间亦未见骨不连、畸形复发、内固定失效等并发症。结论分期策略为治疗青少年儿童严重高弓马蹄内翻畸形提供了新途径,在有效降低并发症的同时,亦可有效提高矫形效果,是一种安全有效的治疗方法。

Objective To evaluate the methods and clincial outcome of staged protocol for severe cavovarus deformity in adolescents.Methods Between June 2013 and June 2015,12 cases of severe cavovarus foot were totally treated in author’s hospital,including 8 males and 4 females with an average age of 11.3 years old（ranged,7-17 years）.All patients were undergone a staged management：the first stage,percutaneous Achilles tendons were lengthened,soft tissues releases were performed and followed with a ring external fixator for gradual realignment.After the alignment mainly restored,a definitive correction was performed at the second stage.The X-ray was taken during the follow-up.The American Orthopedic Foot Ankle Society（AOFAS）ankle,hindfoot score system and visual analogue scale（VAS）score were applied for evaluation.Complications were also recorded.Results No early stage soft tissue complications occurred in all patients.Ten patients obtained an average 21.5 months（ranged,10-34 months）follow-up after the second operation.Xray demonstrated that bone healing was obtained at an average of 12 weeks（ranged,9-16 weeks）.The AOFAS ankle and hindfoot score and VAS score were improved significantly（P〈0.05）.No complications of nonunion,recurrence of deformity or implant failure were seen during follow-up.Conclusion Staged protocol for severe cavovarus deformity in adolescents provides a new approach,which can facilitate the correction and decrease the complication rate.It is proved to be a safe and effective procedure.