跟腱延长、围距骨周围截骨联合Ilizarov技术矫治成人重度僵硬型马蹄内翻足畸形的体会

Experience of achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity

目的:探讨跟腱延长、围距骨周围截骨联合Ilizarov技术矫治成人重度僵硬型马蹄内翻足畸形的体会。方法:收治成人重度僵硬型马蹄内翻足畸形患者15例(20只马蹄足),所有患者均行跟腱Z形延长、围距骨周围截骨联合Ilizarov技术(外固定支架),其中一些较重的患者在此基础上同期加行胫前肌腱转位、跖筋膜松解术。手术7 d后开始旋转相应的螺纹牵伸杆,逐渐矫正足内翻、内收和下垂畸形,同时适当过牵,从而有效矫正畸形。结果:所有患者的重度僵硬型马蹄内翻足畸形在治疗后大部分得到较好的矫正,行走功能恢复,和治疗前相比差异具有统计学意义(P<0.05)。所有患者在治疗后均未出现皮肤坏死、血管神经损伤等并发症。结论:跟腱延长、围距骨周围截骨联合Ilizarov技术矫治成人重度僵硬型马蹄内翻足畸形,不仅具有操作简单、微创和安全等特点,还具有良好的疗效,但在治疗中,应根据患者实际病情选择适宜的治疗方式。

Objective:To investigate the experience of achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity.Methods:15 patients with 20 talipes equinovarus were selected.All patients underwent achilles tendon Z shaped extension,osteotomy around the circumference of the talus combined with Ilizarov technology(external fixation),some of the heavier patients were treated with the anterior tibial tendon transposition and plantar fascia release surgery on the basis of the above treatments at the same period.7 days after surgery we began to rotate corresponding thread threaded rods,gradually corrected within strephenopodia,adduction and drop foot deformity,meanwhile overtension appropriately in order to effectively correct the deformity.Results: Most of the patients with severe talipes equinovarus deformity after treatment got better correction and walking functional recovery.There was a significant difference compared with patients before the treatment,P<0.05 with statistical significance.All of the patients after treatment showed no skin necrosis,vascular and nerve injury.Conclusion:achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity not only has the characteristics of simple operation,minimally invasive and safe,but also has a good effect,but in therapy,appropriate treatment should be selected based on the actual condition of patients.