肌力平衡术治疗先天性马蹄内翻足的远期效果评价

目的 应用Diméglio足评分方法,评价肌力平衡术治疗先天性马蹄内翻足的远期效果,以指导治疗方法的改进.方法 本组共42例,64足,手术时年龄4.5个月～3.5岁(平均1.1岁),均行肌力平衡工期矫形术.＜1岁组33足,≥1岁组31足.术前按Diméglio方法分组,中度畸形组(Ⅱ、Ⅲ型)共34足,重度畸形组(Ⅳ型)共30足.结果 随访5.0～10.5;g(平均8.2年),随访时评分:＜1岁组为(4.58±1.80)分,≥1岁组为(6.26±2.56)分,中度畸形组为(3.62±1.23)分,重度畸形组为(7.40±1.52)分,P＜0.01;畸形改善程度,＜1岁组为(9.61±1.41)分,≥1岁组为(9.23±1.33)分,中度畸形组为(9.15±1.31)分,重度畸形组为(9.73±1.41)分,P＞0.05.随访时按Diméglio分型,Ⅰ型34足,Ⅱ型30足,无Ⅲ、Ⅳ型足.结论 对于DiméglioⅢ型以下的马蹄内翻足,Ⅰ期行肌力平衡术可取得良好的效果,提倡同时切除外展(踩)肌;而对于Ⅳ型足则应采用嘴广泛的软组织松解术.

Long-term results of muscle-strength balancing procedure for congenital clubfoot

Objective To evaluate the long-term results of muscle-strength balancing procedure in the treatment of congenital clubfoot.Methods Forty-two children with 64 clubfeet were treated by muscle-strength balancing procedure.The average age at the time of surgery was 1.1 years(range:4.5 months to 3.5 years).The anterior tibial tendon was transplanted to middle or lateral cuneitorm and the Achilles tendon was lengthened.The clinical outcomes were evaluated according to the of 34 feet with grade Ⅱ or Ⅲ deformity.Group B consisted of 30 feet with grade Ⅳ deformity.Results All patients were followed up for an average 8.2 years(range:5.0 to 10.5 years).Comparison of the pre-operative and the follow-up scores revealed significant improvement in all 64 feet.For the two groups of children under and above the age of 1 year,the scores improved by 9.61±1.41 and 9.23±1.33 respectivel y.For children with moderate and severe deformities,the scores improved by 9.1 5±1.31 and 9.73±1.41 respectively.Conclusions For the clubfeet of grade Ⅱ or Ⅲ,excellent results can been expected from one-stage muscle-strength balancing procedure. As for those with grade Ⅳclubfeet,complete soft tissue release procedure should been performed.Abductor hallucis excision is recommended in all procedures.