Miter构型泰勒空间外固定架治疗重度马蹄高弓足11例临床分析

Clinical analysis of 11 cases of severe equinocavus deformity treated with Taylor Spatial Frame Miter configuration

目的:研究Miter构型泰勒空间外固定架治疗重度马蹄高弓足的疗效和安全性。方法:回顾性分析2015年11月至2021年12月于首都医科大学附属北京积水潭医院收治的11例采用Miter构型治疗的马蹄高弓足患者的临床资料,测量手术前后的负重侧位X线的胫骨距骨角(TTA)、侧位距骨—第一跖骨角(Meary角)等影像学指标,记录术前及术后的美国足踝外科学会(AOFAS)踝—后足评分,采用Likert满意度量表对患者进行满意度评价。结果:11例患者全部获得随访,随访时间(36.00±13.05)个月,男8例,女3例,平均年龄(26.00±10.04)岁,外固定架时间为(121.64±15.35)d。术前TTA(151.30±10.99)°,术后(117.57±3.32)°回到正常范围,差异有统计学意义(P<0.001);术前Meary角(41.98±9.86)°,术后(-2.43±7.97)°回到正常范围,差异有统计学意义(P<0.001)。术后AOFAS评分[(81.18±10.74)分]显著高于术前[(47.18±15.00)分](P<0.001)。9例非常满意,2例满意。6例患者发生了针道感染,1例轻度平足,1例足趾屈曲挛缩畸形,1例前踝撞击,1例轻度马蹄复发,除前踝撞击予以关节镜骨赘清理外其余均保守治疗改善。结论:使用Miter构型泰勒空间外固定架治疗重度马蹄高弓足效果安全、可靠。

Objective:To investigate the efficacy and safety of the treatment for severe equinocavus deformity with Taylor Spatial Frame Miter configuration.Methods:Clinical data of 11 cases of equinocavus patients treat-ed with Miter configuration admitted at Beijing Jishuitan Hospital of Capital Medical University from November 2015 to December 2021 were retrospectively analyzed.The radiological parameters including tibiotalar angle(TTA),lateral talus-1st metatarsal angle(Meary angle)were measured on preoperative and postoperative weight-bearing lateral view X-rays.The American Foot and Ankle Society(AOFAS)ankle-hindfoot score was recorded before and after the surgery.The satisfaction rate was evaluated using Liker scale.Results:Eleven cases were in-cluded with a mean follow-up time of(36.00±13.05)months.There were 3 females and 8 males with the mean age of(26.00±10.04)years.The external fixation time was(121.64±15.35)days.The postoperative TTA(117.57±3.32)˚returned to normal range and was significant different(P<0.001)compared to the preoperative one(151.30±10.99)˚.The postoperative Meary angle(-2.43±7.97)˚returned to normal range and was significant dif-ferent(P<0.001)compared to the preoperative one(41.98±9.86)˚.The postoperative AOFAS score(81.18±10.74)was significantly higher than the preoperative one(47.18±15.00)(P<0.001).The Likert scale showed 9 cases of"very satisfied"and 2 cases of"satisfied".Six patients complicated with pin site infections,one devel-oped mild flatfoot,one had toe contractures,one had ankle impingement and one had mild equinus recurrence.All ameliorated by conservative treatment except for arthroscopic debridement for ankle impingement.Conclu-sion:Severe equinocavus deformity can be treated effectively and safely by the Taylor Spatial Frame Miter con-figuration.