秦泗河手术方法治疗成人创伤后僵硬性马蹄内翻足畸形

QIN Sihe's surgical method for treatment of post-traumatic stiff clubfoot deformity in adults

目的:探讨秦泗河手术方法治疗成人创伤后僵硬性马蹄内翻足畸形的治疗理念、手术策略与临床疗效。方法:回顾性分析2015年1月至2021年5月收治的23例创伤后僵硬性马蹄内翻足患者的临床资料。男15例,女8例,年龄23~57岁,平均年龄(34.9±9.4)岁,患肢均有不同程度的陈旧手术瘢痕、植皮区或皮瓣覆盖,均为跛行步态,14例曾行小腿骨筋膜室综合征切开减张术。采用秦泗河手术方法(挛缩筋膜松解、肌腱延长、动力失衡肌腱移位调整、有限截骨联合Ilizarov技术,术后缓慢牵拉矫正残余畸形),一期手术均达到足踝畸形矫正目标,术后遵照秦泗河提出的“一走,两线,三平衡”下肢重建原则,指导患者带外固定器负重行走锻炼,定期复查,达到骨愈合目标后拆除外固定器,佩带支具保护下锻炼行走,应用秦泗河制定的下肢(足踝)畸形矫正、残缺修复与功能重建术后疗效评价标准进行评价。结果:本组患者手术时间57~143 min,平均(87.7±19.8)mim。术中出血量5~50 mL,平均(19±13)mL。术后调整外固定器时间为14~39 d,平均(17.5±5.0)d,带外固定器时间75~105 d,平均(88.9±8.7)d。所有患者均获得随访,随访时间14~98个月,平均随访(30.2±17.6)个月。采用秦泗河制定的下肢(足踝)畸形矫正、残缺修复与功能重建术后疗效评价标准进行评价,优11足、良9足、可3足、差0足,优良率为86.9%(20/23)。结论:秦泗河手术方法结合了挛缩筋膜松解、肌腱延长、动力失衡肌腱移位调整、有限截骨与Ilizarov技术,术后体外动态调整与评价,一期手术能满意矫正重度僵硬性足踝畸形,手术创伤小,无严重手术并发症,是治疗创伤后僵硬性马蹄内翻足畸形的有效方法。

Objective:To investigate treatment philosophy,surgical strategy and clinical efficacy of QIN Sihe's surgical method in the treatment of post-traumatic stiff clubfoot deformity in adults.Methods:A retrospective analysis was conducted on the clinical data of 23 patients with rigid talipes equinovarus after trauma who were hospitalized from January 2015 to May 2021.There were 15 males and 8 females,aged 23-57 years with an average age of(34.9±9.4)years.The affected limbs had varying degrees of surgical scars,skin grafting,or flap coverage,all with a limp gait.Fourteen cases had undergone decompression surgery for compartment syndrome.QIN Sihe's surgical method(tendon release,tendon transfer,limited osteotomy,power imbalance adjustment,Ilizarov technique)was applied for correction and reconstruction.Active and passive exercise was carried out according to the"one walk,two lines,three balances"rehabilitation principle proposed by QIN Sihe.Regular outpatient examination was conducted.External fixator can be removed when bone healed,and exercise walking was performed under the protection of the orthosis.QIN Sihe's limb deformity correction score was recorded for statistical analysis.Results:The average operation time was(87.7±19.8)min(range,57-143 min),and the average intraoperative blood loss was(19±13)mL(range,5-50 mL).The postoperative adjustment time was(17.5±5.0)days(range,14-39 days),and the external fixation was carried for(88.9±8.7)days(range,75-105 days).The follow-up time was(30.2±17.6)months(range,14-98 months).The QIN Sihe's evaluation criteria for limb deformity correction were used with excellent in 11 feet,good in 9 feet,fair in 3 feet,and poor in 0 foot.The excellent and good rate was 86.9%(20/23).Conclusions:The QIN Sihe's surgical method combines the advantages of tendon release,power imbalance tendon displacement adjustment,limited osteotomy and Ilizarov technique,dynamic regulation and evaluation postoperatively,with minimal surgical invasive and avoidance of serious complications,making it an effective method for treating stiff clubfoot deformity after trauma.