距骨U型截骨结合Ilizarov技术治疗成人距骨发育不良性马蹄足畸形

U-shaped osteotomy of talus combined with Ilizarov technique in the treatment of adult equinus deformity with talus dysplasia

目的:探讨跖腱膜、跟腱等软组织松解延长手术结合距骨周围U型截骨、Ilizarov技术治疗成人距骨发育不良性马蹄足畸形的临床效果。方法:回顾性分析2016年6月至2021年6月采用踝部软组织松解延长、距骨周围U型截骨、Ilizarov技术治疗的12例成人距骨发育不良性马蹄足畸形患者的临床资料。男8例,女4例;年龄34~48岁,平均39.9岁;病因分类:脊髓灰质炎后遗症6例,创伤后遗症4例,脊柱裂和脊髓栓系综合征2例;临床表现分类:单纯马蹄足9例,合并轻度内翻畸形3例;均为单侧肢体;马蹄足畸形25°~40°,平均32.0°;踝关节屈伸活动度15°~30°,平均22.5°。结果:治疗期间2例患者疼痛明显,给予减慢调整速度和间断口服镇痛药物后治疗顺利;3例出现外固定器钉道感染,经换药后得以控制。12例患者均获得随访,随访时间9~18个月,平均12.7个月。马蹄足畸形矫正满意,截骨端均顺利愈合。术后踝关节最大背屈角度5°~15°,平均10.4°;踝关节总活动度30°~40°,平均30.4°;与治疗前比较,均显著提升(P<0.05)。采用马蹄足功能评分系统评估:良11例,可1例,优良率91.6%,较治疗前提升75%。结论:踝部软组织松解结合距骨周围U型截骨、Ilizarov技术治疗成人距骨发育不良性马蹄足畸形,增加了踝关节活动度,同时不改变原有踝关节对应关系,不引发创伤性关节炎等新的并发症,马蹄足畸形纠正满意。

Objective:To explore the clinical efficacy of Ilizarov external fixation technique in the treatment of adult equinus deformity with talus dysplasia and U-shaped osteotomy of metatarsal aponeurosis,Achilles tendon and other soft tissues.Methods:From June 2016 to June 2021,12 patients with unilateral equinus deformity and talus dysplasia were treated by soft tissue release and lengthening,U-shaped osteotomy around talus and Ilizarov external fixation technique.There were 8 males and 4 females with an average age of 39.9 years(range,34-48 years).The deformity was caused by poliomyelitis in 6 patients,trauma in 4 patients,and spina bifida and tetracode syndrome in 2 patients.There were 9 patients with simple equine foot and 3 patients with equinus and mild varus deformity.The average degree of equinus deformity was 32.0°(range,25°-40°).The average ankle flexion and extension range was 22.5°(range,15°-30°).Results:During the treatment period,2 patients had obvious pain,and the treatment smoothly continued after slowing down the adjustment speed and intermittent oral analgesics.The infection of the nail path of external fixator occurred in 3 patients,which was controlled after dressing change.All the 12 patients were followed up for 9-18 months(mean 12.7 months).The equinus deformity was corrected satisfactorily,and the osteotomy ends were healed smoothly.The maximum dorsiflexion angle of the ankle joint was 5°-15°,with an average of 10.4°.The total range of motion of the ankle joint was 30°-40°,with an average of 30.4°.According to the equine foot function scoring system,11 cases were good,1 case was fair,and the excellent and good rate was 91.6%.Conclusions:The release of soft tissue of the ankle combined with U-shaped osteotomy around the talus and the use of Ilizarov external fixation technique in the treatment of adult equine foot deformity combined with talus dysplasia increase the degree of motion of the ankle joint,do not change the corresponding relationship of the original ankle joint,and do not cause new complications such as traumatic arthritis.The equinus deformity can be satisfactorily corrected.