微创松解术治疗婴幼儿先天性垂直距骨

[目的]探讨先天性垂直距骨（congenital vertical talus，CVT）微创松解复位术的临床应用价值。[方法]本组手术由作者用同一种术式完成。先取跟腱止点上内侧小纵切口，松解跟腱、踝关节后关节囊、距下关节囊后部。再取距骨头内侧纵切口，钝性松解距舟关节、距下前关节。视情况于足外侧跟骰关节作第3个小纵切口，松解距下关节。松解完成后，从距骨体后方沿距骨轴穿1枚克氏针向前，距舟关节复位后由足背穿出。为保持距舟、距跟关节的稳定，经足底由跟骨向距骨交叉穿2枚克氏针。[结果]随访时间17—36个月，平均时间28个月，随访结果用Adelaar及Kodros评分标准、评定疗效，优1足，良5足，可2足，差0足。随访末期遗留的畸形，如足跟外翻、前足外展1足，前足旋前1足。随访末期前后位距跟角、前后位距骨第1跖骨角、侧位跟距角、侧位距骨与第1跖骨角基本正常。[结论]手术复位是治疗CVT的唯一方法，早期微创松解术是婴幼儿患者的最佳选择。     

婴幼儿先天性垂直距骨手术治疗体会

目的探讨先天性垂直距骨的手术方法及疗效.方法自2000年4月～2003年3月共手术治疗6例10足先天性垂直距骨,女4例,男2例;神经肌肉型(Ⅱ型)4足,错构综合征型(Ⅲ型)5足,特发型1足.手术时年龄为13～39个月,平均16.5个月.采用足后与足背双切口行一期软组织松解手术跟腱内侧纵切口内延长跟腱,切开踝、距下关节囊.足背踝关节前下方切口(从腓骨小头下方至距舟关节外侧)内切断第三腓骨肌,延长趾长伸肌和腓骨长短肌;松解跟骰、距下以及距舟关节等关节囊;胫前肌止点穿越距骨颈.距舟关节复位后用两枚克氏针分别固定距舟关节和跟距关节.术后踝跖屈石膏固定3个月,然后穿矫形鞋至少12个月.结果6例患者随访时间6～33个月,平均23.1个月.以Adelaar的临床指标和足侧位片测得的距骨轴-第一跖骨基底部夹角(TAMBA),跟骨轴-第一跖骨基底部夹角(CAMBA)为评判标准.术后10足均保持良好外观和足弓,足底无距骨头突出,距下关节和踝关节无明显功能障碍,2足于负重位有轻度跟外翻,7足还未脱离矫形鞋.X线片示无距骨缺血性坏死.平均TAMBA术前66°(50°～98°),随访末期为1.6°(-11°～16°).平均CAMBA术前26.1°(14°～60°),随访末期为-5.45°(-13°～3°).结论手术复位是治疗先天性垂直距骨的惟一方法,单纯软组织松解术是婴幼儿患者的最佳选择.     

先天性垂直距骨1例报告

先天性垂直距骨是一种少见的先天性畸形,具有独特的临床表现和X线征象。我院曾收治一例。一、临床表现及X线征象:患者,武×,女,3岁,右足畸形3年,畸形进行性加重,伴有跛行,不伴有疼痛入院。查体:右足外翻畸形,足底突出,呈摇椅状,足背外侧近踝关节处可见一深的凹陷。足底突出处可摸到一硬性肿物,无压痛,右足僵硬,足内翻跖屈严重受限,负重时畸形无变化。X线片显示:距骨垂直与胫骨纵轴平行一致,舟骨完全脱位到距骨颈背面,前脚背伸,足底软组织轮廓凸出。图1　侧位片图2　背伸应力侧位片图3　跖屈应力侧位片图4　术后X光侧位片二、临床诊断:先天…     

婴幼儿先天性垂直距骨的早期X线诊断

作报告了２０例先天性垂直距骨的早期Ｘ线征象，并测量了３０例正常儿童足作为对照组。作提出以下三点Ｘ线征象可作为配合临床诊断的参考：①跟距轴角偏大与正常组对照有显性差异（正常组：正位均值为２５．１５°±７．０５°，侧位均值为３２．０５°±７°；异常组；正位均值为４５°±９．９°，侧位均值为４５．５°±９．７５°，Ｐ〈（０．０１）；②距跖轴不延续；③跟距轴交点位移。重点讨论了本病的早期Ｘ线诊断标准     

Cincinnati入路治疗儿童先天性垂直距骨

目的 :探讨和总结Cincinnati入路治疗儿童先天性垂直距骨的临床效果和优越性。方法 :对 1组 15例 19足先天性垂直距骨施用Cincinnati入路一次性完全松解距下关节和复位距骨 ,克氏针内固定 ,术后按照Kodros评分标准评价治疗效果。结果 :术后随访 18～ 43个月 ,平均 2 8 3个月 ,优 1足 ,良 14足 ,可 4足 ,无 1例需要再次手术或再脱位。结论 :Cincinnati入路用于治疗先天性垂直距骨具有暴露容易、便于复位固定、并发症少等优点     

微创手术结合外固定器治疗先天性垂直距骨3例初步报告

[目的]探讨利用微创手术结合悬臂式足部外固定架治疗先天性垂直距骨的方法和疗效.[方法]采用足内侧以距骨头为中心横切口,切开关节囊,手法复位,矫正约30°～40°,即部分距舟关节复位,在距骨头处横行穿1枚1.5 mm直径克氏针与外固定架相连.术后利用垂直杆缓慢牵拉距骨复位,复位后用外固定架维持6周,6周后改用石膏制动2个月.去石膏后穿戴矫正鞋.[结果]3例4足术后随访时间平均62个月(6～86个月),以Adelaar评价标准和足侧位X线片观察为指标.术后4足均获得距舟关节完全复位,足负重功能正常.踝关节及跗横关节功能基本正常.1例仍穿戴矫形鞋.[结论]无需广泛软组织松解,采用微创有限手术,应用外固定架缓慢牵拉可以恢复距舟关节脱位,该方法创伤小,术后反应轻,并发症少,是治疗CVT的一个新选择.     

对儿童先天性垂直距骨治疗的实践与思考

垂直距骨患者由于足部异常的负重分布和力学传导,疼痛和行走能力下降会早期出现,有较高的致残率,其自然转归是不能被接受的,有强烈的治疗指征[1-2].正如马蹄内翻足一样,垂直距骨的治疗目标同样是得到灵活而有功能、跖行、无痛的足.实践证实,很难通过单独使用支具和各种改良的矫正器实现畸形的彻底矫正,在增加患者疼痛的同时不能实现...     

婴幼儿先天性斜形距骨诊断与治疗

[目的] 了解和认识婴幼儿先天性斜形距骨.[方法] 31例患者经体格检查,可见平足外翻,内侧纵弓塌陷,不伴有仰趾畸形,而且无肌腱挛缩,无畸形僵硬,被动手法可以恢复正常足弓.足部X线正位片显示距骨轴心线向内倾斜,与第1跖骨相交成角;侧位片距舟关节(半)脱位,距骨-第1跖骨轴线失常;最大跖屈内翻侧位片距骨-第1跖骨轴线恢复正常,均明确诊断为婴幼儿先天性斜形距骨.其中27例采用手法反向牵拉板正,4例手法无效而采用手术切开复位,31例均穿戴特制矫形靴或矫形足托(垫)治疗.[结果] 31例患者均获得痊愈,随访1～2年,平均10个月.随访末期足外形均恢复良好,跟骨无外翻,内侧纵弓恢复.踝足趾功能无障碍,足内外翻肌力平衡,步态稳定,单足负重站立无足外翻.足X线正位片距骨-第1跖骨轴角正常者26例,≤10°者5例.Kite角正常者29例,小于20°者2例.侧位片距舟关节对应良好者31例,距跟角小于25°者6例.[结论] 婴幼儿先天性斜形距骨患者经手法或手术治疗,可以获得痊愈,本病预后良好.     

距骨骨软骨损伤治疗研究进展

踝关节损伤晚期并发症距骨骨软骨损伤,严重影响踝关节功能.根据病史、临床症状及影像学检查一般可确诊,根据临床分期选择合适的治疗方法是取得良好疗效的前提.对急性期无移位或早期距骨骨软骨损伤患者,可采用石膏固定和避免负重的保守治疗方法延缓病程发展.对不稳定或保守治疗无效患者需采用手术治疗,关节镜技术是目前常用的治疗方法,其创伤小且疗效好;内固定的疗效也较好;对缺损较大的患者,可采用自体或异体骨软骨移植术;自体软骨细胞移植术无缺损面积限制,且无供区损伤.该文就距骨骨软骨损伤的分期、诊断及治疗等的研究进展作一综述.     

The treatment of congenital vertical talus.

Operative correction of congenital vertical talus in nine feet in six patients is described. The operation consists of the comprehensive lengthening of the tendons in the foot and full peritalar release without excision of the navicular; it is performed through a dorsal transverse incision.     

Early surgical treatment for congenital vertical talus

Congenital vertical talus is characterised by a dislocated talonavicular joint in association with an equinus position of the calcaneus. We report the results in 13 operated feet in 10 children, 3 of whom (5 feet) presented with a primary neurological disorder and 2 of whom (3 feet) suffered from arthrogryposis multiplex congenita. The other children were normal. All patients were surgically treated by a one-stage procedure which included reduction of the talonavicular joint and correction of the hindfoot equinus, trying to avoid tendon lengthenings and transfers. The age at operation was between the 3rd and the 6th month of life, with one child being operated on later due to other reasons. The patients were reviewed after an average time of 3.5 ± 2.2 years. The clinical results were good or excellent in ten feet. Two feet showed partial or complete recurrence and one foot was slightly over-corrected. Radiographic angle measurements (talo-metatarsal I angle and talocalcaneal angle on the anteroposterior radiograph; talocalcaneal, tibiotalar and tibiocalcaneal angles on the lateral radiograph) returned to normal values in the ten good or excellent feet. Early operative treatment for congenital pes vertical talus leads to very satisfactory functional and cosmetic results, usually avoiding extensive procedures including tendon lengthenings and tendon transfers.     

Surgical treatment of congenital vertical talus using the cincinnati approach

Objectives  

Complete correction of a congenital vertical talus at the subtalar joint complex in 1 sitting. The goal is a restoration of normal shape and function of the foot.     

A new approach to the treatment of congenital vertical talus

Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.