牵拉和选择性胫神经缩窄治疗痉挛性马蹄内翻足

Distraction by Ilizarov frame and selective tibial nerve constriction for spastic talipes equinovarus

[目的]探讨Ilizarov牵拉技术结合选择性胫神经缩窄术治疗脑瘫痉挛性马蹄内翻足的临床疗效。[方法]回顾性选取2015年1月—2019年12月,于本院进行Ilizarov技术结合选择性胫神经缩窄术治疗的脑瘫痉挛性马蹄内翻足患者37例(48足),包括DiméglioⅢ级32足,diméglioⅣ级16足,评估临床和影像结果。[结果]患者手术顺利,无神经血管损伤。手术时间平均(96.9±14.2)min,术中出血量平均(39.7±10.4)ml,部分负重时间平均(6.7±0.9)d,外固定架调整时间平均(8.0±1.1)周,完全负重时间平均(9.9±1.7)周,外固定时间平均(12.2±1.0)周。随访时间平均(18.3±3.6)个月,与术前相比,末次随访时,ICFSG[(37.8±4.0),(8.7±6.4),P<0.05]、MAS评分[3.0(3.0~4.0),1.0(0~3.0),P<0.05]显著降低,踝关节活动度[(12.4±6.9)°,(33.7±10.4)°,P<0.05]和AOFAS评分[(42.1±7.7),(81.2±9.3),P<0.05]显著增加。影像学指标TC[(8.9±3.4)°,(30.0±6.1)°,P<0.05]、TF[(-24.2±13.0)°,(2.6±6.7)°,P<0.05]和LTC[(5.0±2.4)°,(34.8±7.3)°,P<0.05]显著增加。[结论]脑瘫引起的痉挛性马蹄内翻足应用Ilizarov技术结合选择性胫神经缩窄术治疗,矫形效果确切且安全。

[Objective]To investigate the clinical outcomes of distraction by Ilizarov frame combined with selective tibial nerve constriction in the treatment of spastic talipes equinovarus.[Methods]A total of 37 patients(48 feet)with cerebral palsy spastic talipes equinovarus received limited soft tissue release,selective tibia nerve constriction followed by gradual distraction with Ilizarov frame in our hospital from January 2015 to December 2019,including 32 feet of Dimeglio gradeⅢand 16 feet of gradeⅣ.The clinical and imaging documents were evaluated.[Results]All patients had the operations performed successfully without neurovascular injury,with operation time of(96.9±14.2)min,intraoperative blood loss of(39.7±10.4)ml,partial loading time of(6.7±0.9)days,adjustment time of external fixator of(8.0±1.1)weeks,full loading activity time of(9.9±1.7)weeks and external fixator carrying time of(12.2±1.0)weeks.Compared with those preoperatively,the ICFSG[(37.8±4.0),(8.7±6.4),P<0.05]and MAS grade[3.0(3.0~4.0),1.0(0~3.0),P<0.05]significantly reduced,while the dorsal extension-plantar flexion of the ankle[(12.4±6.9)°,(33.7±10.4)°,P<0.05]and AOFAS score[(42.1±7.7),(81.2±9.3),P<0.05]significantly increased at the latest follow up lasted for(18.3±3.6)months.Regarding to imaging,compared with those preoperatively,the TC[(8.9±3.4)°,(30.0±6.1)°,P<0.05],TF[(24.2±13.0)°,(2.6±6.7)°,P<0.05]and LTC[(5.0±2.4)°,(34.8±7.3)°,P<0.05]improved significantly at the latest follow-up.[Conclusion]The Ilizarov technique combined with selective tibial nerve constriction is effective and safe in the treatment of spastic talipes equinovarus caused by cerebral palsy.