小腿后群肌内静脉畸形致马蹄足畸形原因分析及手术治疗

The analysis of equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg and the treatment of surgery

目的分析小腿后群肌内静脉畸形致马蹄足畸形原因,探索相应治疗方法。方法回顾性分析2012年1月至2017年12月就诊于河南省人民医院的小腿后群肌内静脉畸形合并马蹄足畸形病例,共69例,男33例,女36例;年龄2~47岁,平均7.7岁。结合患者主诉、体格检查及MRI检查明确诊断并将致畸原因分为2类。(1)疼痛性障碍:病史、主诉及体格检查提示,患肢镇痛或被动情况下,踝关节背伸可大于75度;(2)挛缩性障碍:病史及体格检查提示患肢镇痛或被动情况下,踝关节背伸小于15度,呈挛缩马蹄足畸形。对于疼痛性障碍患者首选药物保守治疗,效果不佳者行手术治疗。挛缩性障碍患者首选手术治疗。手术方式分为单纯静脉畸形切除术和静脉畸形切除术+跟腱Z形吻合延长术。所有行手术患者术后进行系统功能康复锻炼。随访期间对手术效果进行评价,计算满意率。结果本组69例,疼痛性障碍13例,均首选药物保守治疗,其中4例因效果不佳转行手术治疗,满意率为69.2%(9/13)。挛缩性障碍56例,均采用手术治疗,其中行单纯静脉畸形切除术11例,行静脉畸形切除+跟腱Z形吻合延长术45例。术后随访6个月至2年,除3例有轻度跛行外,其余53例恢复正常功能,满意率为94.6%(53/56),患者自我满意率100%。结论挛缩性障碍是小腿后群肌静脉畸形合并马蹄足畸形的主要病因,首选手术治疗。对于少数疼痛性障碍导致的功能性马蹄足畸形,首选药物保守治疗,如效果不理想,选择手术治疗可以实现较好的治疗效果。

Objective To analyze the causes of equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg,and discuss the corresponding treatment methods.Methods A retrospective study was conducted on 69 cases of intramuscular venous malformations with equinus deformity from January 2012 to December 2017.Based on patient's main complain,physical examination and imaging data,the causes were divided into two categories:pain disorder and contracture disorder.Classification was on the basis of definite diagnosis of MRI.When the main complaint of medical history and physical examination indicated pain relief or passivity of the affected limb,and when the back extension of ankle joint was greater than 75 degrees,it was a pain disorder;when the medical history and physical examination indicated pain relief or passivity of the affected limb,the back extension of ankle joint was less than 15 degrees,it was a contracture disorder.Therapeutic methods included drug conservative treatment and surgical treatment.For the patients with pain disorder,the first choice was drug conservative treatment,and for the patients with contracture disorder,the first choice was surgery.Operative methods include simple venous malformation resection,venous malformation resection and Z-type Achilles tendon anastomosis lengthening.After operation patients received systematic functional rehabilitation exercise and calculated the satisfaction rate.Results 13 cases of painful disorders were firstly treated by conservative medicine,but 4 cases were treated by operation after series of conservative treatments,satisfaction rate was 69.2%(9/13).56 contracture cases were treated by operation,including 11 cases of simple venous malformation resection,45 cases resection and Z-type anastomosis lengthening of Achilles tendon.All the patients were followed up for 6 months to 2 years after operation.53 patients recovered to normal walking after operation,and 3 patients had mild limp,satisfaction rate was 94.6%(53/56).Patient satisfaction was 100%.Conclusions The equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg affect the quality of life.Muscle/tendon contracture was the main cause.Correct surgical treatment combined with early rehabilitation exercise post operation can restore normal walking posture.