有限手术结合Ilizarov技术治疗青少年痉挛性马蹄内翻足的疗效

Limited operation combined with Ilizarov technique in the treatment of adolescent spastic equinovarus foot

目的分析有限手术结合Ilizarov技术治疗青少年痉挛性马蹄内翻足的临床疗效。方法回顾性分析自2005年1月至2015年9月,经有限手术结合Ilizarov技术治疗青少年痉挛性马蹄内翻足46例(74足),男性26例(43足),女性20例(31足),37例为双侧瘫,9例为单侧瘫,术时平均年龄14.6岁(9~31岁),比较术前及末次随访时踝-后足AOFAS评分及Ashworth量化评分。结果 46例(74足)获得随访,平均随访6.4年(1.0~11.7年)。术后佩戴外固定器时间8~12周,平均10周。末次随访时踝-后足AOFAS评分75~88分,平均(80±6.9)分,较术前31~52分,平均(35.7±5.1)分,比较差异有统计学意义(P<0.01)。术后患足胫骨后肌、胫骨前肌、小腿三头肌肌群一组和/或联合肌群肌张力Ashworth分级由平均4级降为2级,比较差异有统计学意义(P<0.01)。7例随访过程中局部固定针感染、松动,5例给予局部乙醇敷料包扎,2例给予更换固定针处理后好转。2例单纯软组织松解及肌力平衡手术术后半年及1年随访后足内翻马蹄畸形复发,给予后足跟距关节截骨固定结合ILizarov外固定术,术后2年随访未见畸形再次复发。未出现严重并发症。结论有限手术结合Ilizarov技术治疗青少年痉挛性马蹄内翻足,能同期缓解痉挛矫正畸形,降低了手术创伤,临床疗效满意,适合大龄痉挛型脑瘫马蹄内翻足患者,值得临床推广。

Objective To investigate the clinical effectiveness of limited operation combined with Ilizarov technique in the treatment of adolescent spastic equinovarus foot.Methods The information of46adolescent patients(74feet)with spastic equinovarus foot who were treated by limited operation combined with Ilizarov technique during the period between January2005and September2015were retrospectively analyzed.There were26males(43feet)and20females(31feet)in this group with an age range of9-31years(median age14.6years).37cases were bilateral paralysis,9cases were unilateral paralysis.AOFAS ankle-hind score and Ashworth score were used to evaluated the clinical effect.Results46patients(74feet)were followed up for1-11.7years(average follow up of6.4years).The time with external fixator were8-12weeks with an average of10weeks.At the time of the latest follow-up,AOFAS anklehind score was75-88with an average of80,which compared with pre-operation number of31-52(average was35.7),the difference has statistically significant(P<0.01).The Ashworth grading of tibialis posterior muscle,tibialis anterior muscle,triceps muscle group,and/or combined muscle group foot muscle tension decreased from grade4to grade2after operation,and the difference was statistically significant(P<0.01).There were no serious complication after the operation.7cases had mild pin tract infection and loose.5of them were treated by local alcohol treatment and oral antibiotics and the other2cases were given to replace the fixed pin.2cases after soft tissue release and muscle balance operation in half a year and1year follow-up appearred varus equinus recurrence.After the hind foot joint osteotomy and Ilizarov external fixation,2years follow-up showed no recurrence of deformity.Conclusion Limited operation combined with Ilizarov technique in the treatment of adolescent spastic equinovarus foot,can relieve spasm and correct the deformity,reduce surgical trauma,achieve satisfactory clinical efficacy,which is suitable for older children with spastic cerebral palsy clubfoot patients.It is worthy of clinical application.