足跖侧松解和跗骨V形截骨治疗儿童高弓足畸形

Planter release and tarsal V-osteotomy for talipes cavus in children

目的 介绍一种软组织和骨性联合手术治疗儿童高弓足畸形的方法 ,并评价其临床效果。方法 对因神经肌肉性疾病所致的高弓足 /高弓内翻足畸形 15例 19足和先天性马蹄内翻足术后遗留高弓足畸形 1例 1足 ,采取足跖侧软组织松解和足跗骨V形截骨联合手术的治疗方法 ,术后用小腿管型石膏固定 6周。主要从足外形的改善、足负重及行走功能和X线测量评价手术效果。结果 本组平均获得随访 3年 6个月。跗骨截骨均于术后 6～ 8周愈合。术后 10周开始负重和行走。除 3例高弓足畸形复发并后足内翻加重 ,17足外形、足负重及行走功能均明显改善 ,X线测量Meary角由术前平均 2 5°减少至 5°以下。本组优者 8足、良者 9足、差者 3足 ,优良率为 85 .0 %。结论 足跖侧软组织松解和足跗骨V形截骨联合手术是治疗儿童高弓足 /高弓内翻足畸形确实有效的方法 ,对大于 6岁儿童足的生长发育无明显的不良影响。但是 ,对进行性神经肌肉性病变所致的高弓足 /高弓内翻足畸形 。

Objective To describe a combined procedure of tarsal V osteotomy and planter soft tissue release in the treatment for talipes cavus or cavovarus deformity and its clinical efficacy in children. Methods Sixteen children with talipes cavus or cavovarus deformity (19 feet) from neuromuscular disease and club foot (one foot) were treated by a combination of tarsal V osteotomy and planter soft tissue release. The foot and leg were immobilized in cylinder cast for 6 weeks after operation. The results were evaluated according to the appearance, the weight bearing function and X ray measurement.Results An average of 3.6 years follow up was obtained.Healing of tarsal osteotomies was achieved within 6～8weeks and all children began walking 10 weeks postoperatively.The appearance, weight bearing and walking were significantly improved in seventeen feet and Meary angle decreased from 25 degree to 5 degree postoperatively on average. Conclusion Planter release and tarsal V osteotomy are effective management for talipes cavus deformity in children