22 062例足踝畸形患者临床特点分析(秦泗河矫形外科数据库1978年5月25日—2020年12月31日)

Clinical characteristics analysis of 22 062 patients of foot and ankle deformity from QIN Sihe Orthopaedic Surgery Database between May 25, 1978 and December 31, 2020

目的 基于秦泗河矫形外科数据库中足踝畸形患者临床资料,分析足踝畸形发病特征与治疗策略,为临床决策提供依据。方法 检索秦泗河矫形外科数据库,纳入1978年5月25日—2020年12月31日接受矫形手术治疗的22 062例足踝畸形患者。统计患者性别、手术时年龄、区域分布、病因、畸形种类、手术方式、术后固定方式等信息。结果 22 062例患者中,男13 046例(59.13%),女9 016例(40.87%);手术时年龄1~77岁,中位数17岁,其中5~40岁人群有20 026例(90.77%)。患者来自全国32个省市自治区以及印度、美国等5个国家。病因、病种涵盖154个,其中脊髓灰质炎后遗症、脑性瘫痪、脊柱裂与脊髓栓系、先天性马蹄内翻足、创伤后遗足踝畸形以及腓骨肌萎缩症占比最高。畸形种类包括内翻足、马蹄足、外翻足、仰趾(跟行)足、马蹄高弓(凹弓)足、单纯高弓畸形、爪形趾畸形、连枷足(夏科病)8类。手术方式包括肌腱延长术、软组织松解术、肌腱转位术、截骨矫形术与足踝关节融合术等36 620术次;足踝畸形矫正术同期实施髋、膝、小腿手术11 561例次。术后足踝固定方式包括Ilizarov外固定器2 709例(12.28%),组合式外固定器3 966例(17.98%),石膏或支具固定15 387例(69.74%)。结论 足踝畸形男性患者比重大,人群分布以青少年为主,地域及病因、病种分布广,马蹄足、内翻足是主要畸形类别。足踝畸形多合并下肢其他部分畸形,需要整体治疗。足部软组织、骨性手术结合Ilizarov外固定器、组合式外固定器的应用为复杂足踝畸形矫正提供了保证。

Objective Based on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making. Methods A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method,postoperative fixation method, and other information were collected. Results Among the 22 062 patients, there were13 046 males(59.13%) and 9 016 females(40.87%);the age at operation ranged from 1 to 77 years, with a median of 17years, and 20 026 cases(90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds(of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord,congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus,equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release,tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases(12.28%), combined external fixator in 3 966 cases(17.98%), and plaster or brace fixation in 15 387 cases(69.74%). Conclusion Male patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.