不同年龄段马蹄内翻足治疗方法的选择

The choice of treatment methods of equinovarus in different age stages

目的 探讨不同年龄段马蹄内翻足治疗方法的选择。方法 将105例马蹄内翻足畸形患者(123足)根据不同年龄段分为3组:(1)婴幼儿组5例(7足),均采用Ponseti系列石膏固定+跟腱切断术。(2)青少儿组40例(47足),11足行肌腱转位等软组织手术+石膏或组合外固定架固定,7足行单纯Ilizarov牵伸,29足行肌腱转位等软组织手术和(或)有限截骨距下或三关节融合+Ilizarov技术固定。(3)成年组60例(69足),19足行肌腱转位等软组织手术+石膏或组合外固定架固定,42足行肌腱转位等软组织手术+有限截骨距下关节或三关节融合+Ilizarov技术固定,8足行踝关节融合。结果 患者均获得随访,时间18个月~4年。末次随访时,采用国际马蹄足畸形研究学组评分为3~15分,其中优77足,良38足,可8足,优良率为93.5%。(1)婴幼儿组:术后随访过程中,无明显并发症及复发,足外形正常,足底可负重行走。(2)青少儿组:术后2例针道感染,2例残留轻微足跟内翻,其余患者未发生相关并发症,恢复满意。(3)成年组:术后3例针道感染,2例矫形过程中发生距骨脱位,1例马蹄足未完全矫正,1例矫正后复发,4例残留有轻微足跟内翻,2例有明显足跟内翻。8例踝关节融合术患者总体满意度不高。结论 马蹄内翻足的治疗,根据患者年龄和严重程度选择相应治疗方案,可取得良好的临床疗效。

Objective To explore of the choice of the treatment methods of equinovarus in different ages.Methods The 105 patients with equinovarus(123 feet) were divided into three groups according to different ages:(1) The infant group:5 patients(7 feet) were all treated with Ponseti series plaster fixation and achillotomy.(2) The adolescent group:40 patients(47 feet), of which 11 feet were performed with soft tissue surgery such as tendon transposition plus plaster or combined external fixator;7 feet were treated with Ilizarov traction alone,29 feet were treated with tendon transposition and/or limited subtalar joint osteotomy or triple joints fusion plus Ilizarov technique fixation.(3) The adult group:60 patients(69 feet),of which 19 feet were treated with tendon transposition plus plaster or combined external fixator,42 feet were adopted with soft tissue surgery such as tendon transposition plus limited subtalar joint or triple joints fusion plus Ilizarov technique fixation,and 8 feet were treated with ankle joint fusion.Results All patients were followed up from 18 months to 4 years. At the last follow-up,the scores assessed with the international equinovarus deformity study group were 3 ~ 15 points,of which 77 feet were excellent,38 feet were good and 8 fair,the excellent-good rate was 93. 5% .(1) The infant group:during postoperative follow-up,there were no obvious complications and recurrence cases,the feet were normal appearance,and the plantar could walk with load.(2) The adolescent group:2 patients had needle tract infection,2 patients had slight residual varus,and the rest patients had not related complications and recovered satisfactorily.(3) The adult group:there were 3 cases of needle tract infection after surgery,2 cases of talus dislocation during orthosis,1 case of incompletely corrected equinovarus,1 case of recurrence after correction,4 cases of slight residual varus,and 2 cases of obvious varus. The overall satisfaction of 8 ankle arthrodesis were not high.Conclusions For the treatment of equinovarus,according to the age and severity of the patients,the corresponding treatment can obtain good clinical efficacy.