伊利扎诺夫技术治疗儿童顽固性马蹄内翻足

The treatment of refractory clubfoot in children by Ilizarov technique

目的 提高儿童顽固性马蹄内翻足畸形的治疗效果。方法 应用伊利扎诺夫技术治疗儿童顽固性马蹄内翻足畸形 11例 12足。先行跟腱延长和足后路松解 ,再在胫骨中下 1/ 3处、跟骨及 1～ 5跖骨骨干多平面贯穿张力细克氏针或橄榄针 ,分别固定于环形、半环形及马蹄形骨外固定器上 ,并通过多根螺纹杆相互连接成三维立体的骨外固定装置。通过对骨外固定装置各部件间距进行延长、压缩和旋转等调节 ,以及舟、骰骨的截骨延长 ,从而矫正畸形足的下垂、内翻、内收及短足畸形。结果 术后随访时间 2～ 10年 ,平均 4 5年。按Garceau分级标准评定 :优 5例 6足 ,良 4例 4足 ,可 2例 2足 ,优良率达 83 3%。有 2例 2足遗留轻度前足内收畸形 ,4例 4足有较明显的跗骨间关节僵硬 ,但其步态和负重力线均与正常儿童无明显差别。结论 应用伊利扎诺夫技术治疗儿童顽固性马蹄内翻足疗效好 ,副作用小 ,但应严格掌握手术适应证。

Objective To improve the treatment of refractory clubfoot in children. Methods 12 refractory clubfeet in eleven patients were treated by Ilizarov technique. After Achilles tendon was lengthened and posterior released, two Kirschner's wires were passed horizontally through the middle of the tibia and fixed under tension to a ring. Similar wires(or olive wires) were then placed transversely through calcaneus and metatarsals and each was fixed to a half ring. The tibial and calcaneal rings were attached to each other by three bars; the calcaneal and metatarsal rings were connected by two links which allow dorsiflexion at the ankle. Forefoot adduction was corrected by greater distraction of the medial side than that of the lateral side. Equinus deformity was corrected by lengthening the posterior bars between the tibial and metatarsal rings. The navicular and cuboid were distraction osteogenesis to correct foot adduction and shortening deformity. Results The patients were followed up for 2～10 years .The results were excellent in 5 cases (6 feet), good in 4 cases (4 feet), fair 2 cases (2 feet) according to the Garceau standard scale. The rate of excellent and good clinical results was 83 3%. Conclusion The Ilizarov technique is a safe and effective method to treat refractory club foot in children, but indications should be selected strictly.