Ilizarov技术矫正儿童僵硬性马蹄内翻足

Treatment of severe rigid talipes equinovarus deformity with Ilizarov technique in children

目的探讨Ilizarov技术矫正儿童僵硬性马蹄内翻足畸形的适应证、治疗方法和治疗效果。方法回顾分析2014年7月至2016年7月湖南省儿童医院应用Ilizarov软组织牵张技术联合(不联合)软组织松解术治疗DimeglioⅢ级和Ⅳ级学龄期儿童僵硬性马蹄内翻足15例(20足)的病历资料。其中男10例,女5例;平均年龄75个月(52～97个月);双侧5例,单侧10例;根据Dimeglio先天性马蹄内翻足分级标准进行分级,Ⅲ级9例(12足),Ⅳ级6例(8足)。其中未经治疗的先天性马蹄内翻足7例(9足),经Ponseti方案治疗后复发马蹄足畸形3例(4足),先天性多发性关节挛缩症所致马蹄足畸形1例(2足),Charcot-Marie-Tooth病所致马蹄足畸形1例(1足),脊髓拴系综合征所致马蹄足畸形1例(2足),创伤后瘢痕挛缩所致马蹄足畸形1例(1足),小腿神经鞘瘤术后马蹄足畸形1例(1足)。Ilizarov外固定架平均应用时间为18周(17～21周),Ilizarov外固定架拆除后,应用膝下管形石膏固定踝关节和足部6个月,之后夜间支具固定直至骨骼成熟。结果术后平均随访时间26个月(12～36个月),术后所有患儿畸形足获得满意的跖行足外观,行走无疼痛,踝关节平均活动范围15°(10°～30°),1例(2足)因患儿术后未能遵医嘱佩戴支具复发,需要再次行Ilizarov外固定矫形术。按Dimeglio先天性马蹄内翻足分级标准评定疗效,优14足,良4足,差2足,优良率为90%。结论 Ilizarov外固定矫形技术具有四维、微创、可重复、适用范围广泛等优点,对于矫正儿童僵硬性马蹄内翻足效果显著,尤其适用于8岁以下儿童的重度僵硬马蹄内翻足。但是该技术难度较大,学习曲线较长。

Objective To evaluate the results and indications of Ilizarov technique in treatment of the severe rigid clubfoot deformity of children. Methods From July 2014 to July 2016, 15 cases （20 feet） with Dimeglio＇s type HI or IV clubfoot deformity were treated by Ilizarov technique combined with or without soft tis-sue release in Hunan Children＇ s Hospital. They were including 10 meiles and 5 females, with an average age of 75 months （52-97 months）. Five patients were involved in bilateral feet, and 10 cases in unilateral. The clini-cal data of those patients were analyzed retrospectively. According to Dimeglio＇ s classification system, 12 feet in 9 cases were graded in type IH , and 8 feet in 6 cases were type IV. The foot deformity was resulted from untreated congenital clubfoot in 7 patients （9 feet） , recurrence after Ponseti method treatment in 3 cases （4 feet） , congenital multiple arthrogryposis in one patient （2 feet） , Charcot-Marie-Tooth syndrome in one case （one foot） , tethered spinal cord syndrome in one patient （2 feet） , scar contracture after trauma in one case （one foot） , and schwannoma involved in the calves in one case （one foot）. Results All the patients were followed up for mean 26 months （12-36 months） , and the Ilizarov device were removed at average 18 weeks （17-21 weeks） postoperatively. All the patients but one whose deformities were recurred, were treated satisfac-torily with plantigrade, painless foot, and the range of motion in the involved ankle was average 15° （10°-30° ） .Based on Dimeglio grade method, 14 feet were excellent, 4 feet were good, and 2 feet were poor, with a total of excellent and good grade of 9 0%. Conclusion The Ilizarov technique is an optional method for treating severe rigid clubfoot deformity in children, even though the technique is difficult and need a relative long learning cure to master.