可调组合式足踝畸形外固定矫形器的系列构型与临床应用原则

目的介绍可调组合式足踝畸形外固定器的系列构型及探讨该装置的临床应用原则。方法在原来Ilizarov器械的基础上改进了一些适合国人的外固定矫形器,新设计的足踝部外固定器,仅由几组环和不同的配件组成,足踝部的马蹄、高弓、内外翻等畸形,根据情况只需增加、减少零部件或少许改变器械构型,就能够同时矫正。结果该组合装置经过临床应用,证实了器械结构合理性,具有结构简单,操作方便的优点。适用于脊髓灰质炎后遗症、外伤、脊椎裂后遗症、先天性疾病等各种原因引起的足踝畸形。不但避免很多严重的并发症,而且取得了非常满意的临床效果。结论新型的踝足外固定器,拓宽了手术指征,治疗了一些既往传统骨科难以治疗的重度踝足畸形,取得了非常理想的效果。在遵循人体自然规律和基本法则的前提下,按照Ilizarov技术的理念,重建人体的结构与功能,形成一套更加完善的外固定治疗体系。     

Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形

目的探讨Ilizarov技术矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形的手术方法、术后管理程序及疗效。方法2004年2月～2007年5月，根据Ilizarov张力一应力法则，应用自行研制的外固定矫形器治疗伴有皮肤瘢痕挛缩的足踝畸形12例，其中马蹄内翻足10例，马蹄外翻足2例。9例同期实施足跗骨的有限截骨术，3例实施足部肌腱转移肌力平衡术，1例同期实施胫骨延长术。术后5d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，足内翻者先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准，足外翻者牵拉矫形的方向与内翻足相反。在矫形的过程中定期进行x线检测，以防止发生踝关节前后移位。治疗期间鼓励患足负重行走。术后平均牵伸78d，停止牵伸后在外固定器维持下患足负重行走平均69d，拆外固定器后配矫形鞋行走2～3个月。结果12例患者术后随访5个月～2年4个月（平均1年5个月）。8例足畸形获满意矫正，能全足底负重，行走功能良好，患者满意。4例足下垂畸形出现部分复发，其中3例再次安装足踝牵伸器矫正。最终疗效11例满意，1例可。僵硬的瘢痕组织经牵拉后血液循环改善，皮肤瘢痕变软。无一例发生严重针道和皮肤切口感染，未并发踝关节脱位及血管、神经损伤等并发症。结论改良的Ilizarov微创技术能有效矫正合并皮肤瘢痕挛缩的僵硬型足踝畸形，合并骨性畸形者应配合有限截骨手术，但牵拉过程必须缓慢。足踝畸形达到矫形要求后，患足全负重行走不少于8周再拆除外固定器，可避免或减少畸形反弹。皮肤瘢痕组织在张应力作用下，可出现血液循环改善与组织再生的现象。     

改良Ilizarov技术结合有限手术矫正马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正马蹄内翻足畸形的手术方法及器械改良、术后管理方法的改进及疗效。[方法]2003年1月～2006年5月，根据Ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循Ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准。在矫形的过程中定期进行X线检测，以防止发生踝关节前后移位，治疗期间允许患足负重行走。术后平均牵伸42d，拆外固定器后患足再上石膏固定适当时间。[结论]32例患者术后均获得随访，其中26例为来院复查。随访时间1年～3年1个月，平均1年5个月。畸形均获满意矫正，足持重行走功能良好，患者满意。本组无1例发生严重针道感染和切口感染，未并发踝关节脱位及血管、神经损伤等并发症。[结论]改良Ilizarov技术矫正马蹄内翻足畸形，手术创伤小、安全，治疗效果提高，配合有限矫形手术，能够矫正传统矫形手术难以治疗的严重足畸形，缩短治疗周期，避免了严重手术并发症。     

骨外固定技术治疗脊柱裂后遗足踝畸形

[目的]总结骨外固定技术治疗脊柱裂足踝畸形的主要方法、优势及综合疗效。[方法]2012年3月~2016年4月,回顾性分析本科就诊并手术的脊柱裂足踝畸形248例患者,男121例,女127例;平均年龄25.5岁。左侧49例,右侧53例,双侧146例。按外固定器使用种类,使用Ilizarov外固定器115例,使用组合式外固定器107例,11例同时使用了Ilizarov外固定器+组合式外固定器。同期实施跟距关节截骨、三关节截骨、第一跖骨基底截骨、跟腱松解、胫后肌延长、跟腱固定等手术。[结果]248例患者获得近期随访,所有足踝畸形均得到有效矫正,恢复全足跖行负重,未出现外固定手术相关的神经血管损伤等并发症,针道感染5例5针道,钢针断裂1例,1例跟骨内侧针道发生热烧伤,经换药后愈合。1例发生外固定相关皮肤过敏湿疹,3例马蹄内翻足畸形调整过程中发生胫距关节前脱位,改变外固定构型后矫正。235例获得门诊和电话随访,平均随访时间28.5个月,AOFAS足踝评分平均88.7分,与术前比较,P=0.013<0.05,差异具有统计学意义。依照秦泗河肢体残疾矫正的评价标准进行评价,优180足,良55足,可0足,优良率100%。[结论]骨外固定技术是治疗脊柱裂各种类型足踝畸形的有效方法,简便微创,可靠可调,可以规避严重的并发症。     

组合式外固定器治疗合并患肢短缩的足踝部畸形

背景：传统的足踝部畸形的矫正需要通过手术来完成,术后需要“静态”的维持。Ilizarov技术遵循的“张力-应力法则”和“牵拉组织再生技术”,在一定程度上打破了传统的矫形模式。目的：探讨Ilizarov技术治疗合并患肢短缩的足踝部畸形的临床疗效。方法：回顾分析2006年8月至2012年10月采用Ilizarov技术治疗的17例下肢及足踝部畸形患者的临床资料。其中男10例,女7例,年龄20~37岁,平均27.5岁。脊髓灰质炎后遗症导致患肢短缩合并足踝负重位外翻畸形患者5例,先天性马蹄内翻足合并患肢短缩7例,高弓足合并患肢短缩3例,跟腱挛缩、仰趾畸形合并患肢短缩2例。所有患者在有限手术重建足踝部软组织平衡或者截骨矫正畸形后安装Ilizarov组合式外固定支架,同时做胫骨的延长。结果：17例患者佩戴Ilizarov支架的时间是16~44周,足踝部矫形支架在3~6个月矫形满意、骨融合确实后单独拆除,骨延长支架根据需要继续佩戴。所有患者都获得随访,随访时间6~48个月,患肢延长2~6 cm,延长段骨矿化满意,足踝部矫形满意。足踝功能参照AOFAS评分：术前（43±5.1）分,术后（76±7.2）分。结论：对于各种原因导致的合并下肢短缩的足踝部畸形的矫治,Ilizarov技术灵活的器械组合可同时完成多方向的畸形矫正,在矫正畸形的同时实施骨延长术。     

外固定器治疗脊髓栓系综合征僵硬性足部畸形

[目的]观察外固定器治疗脊髓栓系综合征僵硬性足部畸形的临床效果,探讨脊髓神经源性足部畸形外科矫正和功能重建的新技术.[方法] 1988年10月～2006年6月,回顾性分析脊髓栓系综合征僵硬性足部畸形61例97足;年龄6～42岁,根据足部畸形的特征,设计不同构型的外固定器.上运动神经元损伤型足部畸形主要实施选择性胫神经缩窄手术和距下关节外融合手术或距下关节融合术,同时安装外固定器.下运动神经元损伤型足部畸形主要实施软组织松解、肌腱转位术或截骨手术,同时安装外固定器.[结果]得到至少3年随访的54例、86足进行分析,马蹄内翻足39足,马蹄足21足,马蹄外翻足16足,跟行足6足,高弓足4足.其中上运动神经元损伤型足部畸形19足,下运动神经元损伤型67足.佩戴外固定器时间8～12周,平均11周.采用Laaveg - Ponseti足功能评分系统:优38足,良29足,可13足,差6足.优良率77.9％.第1次术后复发3足,复发率3.5％.钉道感染18足,清理炎性分泌物或更换钉道位置后治愈.足底溃疡3足,清创和短期避免负重后治愈.[结论]外固定器治疗脊髓栓系综合征僵硬性足部畸形符合生物学重建理论,可提高疗效,减少复发.     

有限矫形手术与Ilizarov技术治疗青少年先天性马蹄内翻足

目的观察应用有限矫形手术与Ilizarov技术治疗青少年先天性马蹄内翻足(congenital clubfoot,CCF)的临床疗效,探讨CCF外科矫正与功能重建新技术、新理念。方法 2003年9月-2010年7月,收治25例40足青少年CCF。男14例20足,女11例20足;年龄12～25岁,平均15.7岁。左足4例,右足6例,双足15例。根据秦氏马蹄内翻足畸形分度:Ⅰ度9足,Ⅱ度17足,Ⅲ度14足。合并小腿内旋畸形9足,右侧髋关节半脱位1例。采用有限软组织松解与骨性截骨手术后,9足Ⅰ度畸形者安装组合式外固定器,31足残留畸形安装Ilizarov外固定牵伸器。术后5～7 d开始矫正,以0.5～1.0 mm/d为宜;待踝关节矫正至过伸5～10°,足呈轻度外翻后停止牵伸,矫正位携带外固定架并负重行走4～6周。双足畸形患者分两期进行手术,手术间隔3～6个月,平均4个月。结果 9足术后佩戴组合式外固定器6～12周,平均8周;31足佩戴Ilizarov外固定牵伸器6～17周,平均13周。患者均获随访,随访时间8个月～6年,平均37个月。牵拉矫形期间6例6足发生针道轻度感染,均经对症处理后感染消失。术后2年1例1足畸形部分复发,经再次安装Ilizarov外固定牵伸器负重行走4周,矫正满意;其余畸形足在随访期内均获得满意矫正和全足底持重。末次随访时根据国际马蹄足畸形研究会(ICFSG)的评分系统,获优28足,良10足,可2足,优良率95%。结论有限矫形手术结合Ilizarov技术矫治青少年CCF,符合生物学原理和微创外科原则,安全、微创、疗效确切。该马蹄内翻足手术矫形策略遵循骨科自然重建理念,尤其适用于传统矫形骨科手术难以治疗的Ⅲ度CCF。     

计算机辅助Taylor外固定架结合足部截骨治疗成人严重马蹄内翻足

[目的]探讨计算机辅助Taylor外固定架治疗成人马蹄内翻足畸形的临床疗效。[方法]应用计算机辅助Taylor外固定架技术,结合有限矫形手术治疗11例(14足)多种原因引起成人重度马蹄内翻足畸形。术后牵伸60~92 d,平均72 d,拆除外固定器后,穿矫形鞋行走6~9周。[结果]11例均获随访,时间11~37个月,平均23个月。畸形矫正均满意,截骨处均骨性愈合,足负重行走功能良好。根据国际马蹄足畸形研究会(ICFSG)评分系统:优10足,良3足,可1足。无严重并发症发生。[结论]应用计算机辅助Taylor外固定架结合足部有限截骨技术,能够矫正传统矫形手术难以治疗的重度马蹄内翻足畸形且疗效满意。     

Ilizarov外固定架治疗青少年Ⅲ度马蹄内翻足畸形

目的探讨Ilizarov外固定架治疗青少年Ⅲ度马蹄内翻足畸形的临床疗效。方法应用研究Ilizarov技术,结合有限矫形手术治疗12例多种原因引起的青少年Ⅲ度马蹄内翻足畸形患者(17足)。术后佩戴外固定架。结果 12例均获随访,时间12~49个月。佩戴外固定架时间8~12周。畸形矫正均满意,截骨处均骨性愈合,足负重行走功能良好。根据国际马蹄足畸形研究会(ICFSG)评分系统:优10足,良6足,可1足。无严重并发症发生。结论应用Ilizarov技术结合有限的矫形手术,遵循个体化和局限化的原则,能够矫正传统矫形手术难以治疗的Ⅲ度马蹄内翻足畸形,疗效满意。     

22 062例足踝畸形患者临床特点分析（秦泗河矫形外科数据库1978年5月25日—2020年12月31日）

目的 基于秦泗河矫形外科数据库中足踝畸形患者临床资料，分析足踝畸形发病特征与治疗策略，为临床决策提供依据。方法 检索秦泗河矫形外科数据库，纳入1978年5月25日—2020年12月31日接受矫形手术治疗的22 062例足踝畸形患者。统计患者性别、手术时年龄、区域分布、病因、畸形种类、手术方式、术后固定方式等信息。结果 22 062例患者中，男13 046例（59.13%），女9 016例（40.87%）；手术时年龄1～77岁，中位数17岁，其中5～40岁人群有20 026例（90.77%）。患者来自全国32个省市自治区以及印度、美国等5个国家。病因、病种涵盖154个，其中脊髓灰质炎后遗症、脑性瘫痪、脊柱裂与脊髓栓系、先天性马蹄内翻足、创伤后遗足踝畸形以及腓骨肌萎缩症占比最高。畸形种类包括内翻足、马蹄足、外翻足、仰趾（跟行）足、马蹄高弓（凹弓）足、单纯高弓畸形、爪形趾畸形、连枷足（夏科病）8类。手术方式包括肌腱延长术、软组织松解术、肌腱转位术、截骨矫形术与足踝关节融合术等36 620术次；足踝畸形矫正术同期实施髋、膝、小腿手术11 561例次。术后足踝固定方式包括Ilizarov外固定器...     

Complex foot deformities associated with soft-tissue scarring in children.

Two cases of deformities in scarred feet are presented. One case had an old, well healed forefoot amputation with severe equinovarus deformity, and the other had an equinus deformity following a burn injury 10 months prior. Both the cases were managed by primary release of the contracted joint capsules. The correction of the soft-tissue contractures was achieved by gradual distraction using the Ilizarov apparatus. The clinical presentation and surgical treatment of complex foot deformities, complicated by the presence of scar tissue, are presented. These cases illustrate the benefits of combining soft-tissue release with the Ilizarov technique of distraction histogenesis in the treatment of complicated foot deformities associated with scarring in pediatric patients.     

Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation

The purpose of this study was to determine recurrence rates of pediatric foot and ankle burn deformities treated with the Ilizarov method. A total of 19 patients with 29 foot and ankle deformities were studied. The most common deformity treated was equinus (23). Rocker-bottom and cavus foot deformities were each treated three times. The average age of the patient at the time of the burn injury was 3.2 years, and the average age at the time of fixation was 9.4 years. Equinus contractures averaged -34 degrees (34 degrees of plantarflexion) before surgery and +7 degrees (7 degrees of dorsiflexion) after treatment with the Ilizarov fixator. The recurrence rate for all 29 ankles and feet was 69% (20/29). The recurrence rate for equinus contractures was 74% (17/23). The average time to recurrence was 17.3 months. Only short-term follow-up was available on four of the six feet and ankles that did not recur. Deformity correction in burned feet and ankles is difficult to obtain by any means. The authors recommend using the Ilizarov method to obtain correction of moderate to severe foot and ankle deformities in pediatric burn patients, but the correction obtained is not stable and deformity will likely recur. Parents and patients should anticipate adjunctive nonoperative and operative procedures to keep their feet plantigrade as they grow. In young children, the possibility of having additional surgeries, including repeat Ilizarov procedures, should be discussed. Even older children should expect additional surgeries to prevent recurrent deformities.     

Treatment of severe equinus deformity associated with extensive scarring of the leg.

Nine severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using a hinged Ilizarov apparatus and free-tissue transfer. The average duration of followup was 38 months (range, 28-54 months). Free tissue transfer was done in all patients; a parascapular flap was used in seven patients, and a groin flap was used in two patients. The results were evaluated using two objective criteria and one subjective assessment: the degree of active dorsiflexion, the range of active movement of the ankle, and daily activities. For active dorsiflexion of the ankle and activities, the results were good in seven patients and fair in two patients. For range of active motion of the ankle, the results were good in six patients and fair in two patients. One patient with ankle arthrodesis was excluded. This study showed that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively with heel cord lengthening, free-tissue transfer, and a hinged Ilizarov technique.     

External fixation use in arthrodesis of the foot and ankle

The use of external fixation in foot and ankle arthrodesis can be beneficial. Its advantages, disadvantages, and indications were reviewed in this article. External fixation offers the surgeon an opportunity to treat complex foot and ankle deformities, trauma, chronic infections, pseudoarthroses, soft tissue contractures, and limb length discrepancies in ways that were unavailable before its advent. The Ilizarov technique requires considerable experience and patient compliance for the best postoperative outcome. An understanding of musculoskeletal physiology and the biomechanics of bone and soft tissue are essential for the competent application of external fixators in general and Ilizarov frames in particular. The surgeon should be aware of all the surgical options before the application of an external complex apparatus.     

Ilizarov技术矫正手与前臂畸形的临床应用研究

[目的]探讨用Ilizarov技术矫正手与前臂畸形的器械研制、手术方法与疗效。[方法]2例桡骨感染性大段缺损,伴肘、腕关节畸形,年龄11和12岁。3例手外伤后形成瘢痕挛缩畸形,其中手虎口挛缩1例;第2、3手指蹼挛缩1例;食指重度屈曲挛缩1例,年龄13~27岁。前臂缺损牵伸治疗应用标准的Ilizarov器械与技术,手的畸形矫正应用自行研制的微型骨外固定牵拉器,并进行了穿针布局和牵拉应力的测试,术后按要求缓慢旋转螺纹杆,使疤痕挛缩的组织产生持续的张力,缓慢矫正畸形,其中2例前臂缺损和1例指蹼挛缩者,结合实施了有限度的骨性与软组织手术。[结果]5例病人治疗结束后平均随访7个月,全部达到满意的矫形治疗效果,功能较术前获得明显改善,未出现并发症。[结论]应用Ilizarov技术修复前臂的残缺,矫正手的畸形,具有微创、简单、疗效确切的优点,不会产生严重的手术并发症。     

Correction of severe residual clubfoot deformity in adolescents with the Ilizarov technique

Correction of severe residual clubfoot deformities in adolescents is a difficult undertaking and historically has had mediocre success without an accompanying arthrodesis procedure. Soft tissue release alone has yielded extremely high recurrence rates. Additional osteotomies have been used for correction of single deformities in one plane. The use of Ilizarov external fixation techniques has allowed for improvement of correction, stabilization, and decrease in recurrence rates. The technique, however, is difficult and should be performed by surgeons who are familiar with correction of pediatric foot and ankle deformities and are versed fully in Ilizarov fixation techniques.     

Correction of equinus deformity by means of a new unconstrained ilizarov frame system

PurposeThis study aimed to clarify the effectiveness of a novel technique utilizing the new unconstrained Ilizarov frame system by evaluating the clinical outcomes of equinus deformity correction.MethodsFrom January 1998 to December 2012, a total of 9 consecutive patients (median age: 33 years) with equinus deformity were treated by using a simple, unconstrained, hinge-less Ilizarov frame, which was developed to correct talar subluxation using an unconstrained frame system. All patients had equinus deformity >30°, although preoperative radiographs showed a congruous ankle joint with no fixed bony deformity. Preoperative equinus deformity was evaluated as well as dorsal flexion (DF) in Ilizarov at 3 months after removal and at final follow-up. Furthermore, the presence or absence of talar subluxation at the time removal of the Ilizarov apparatus, and whether or not ankle arthrodesis was finally indicated, was evaluated.ResultsMedian follow-up period was 76 months. Median preoperative equinus deformity was −40° None of the patients showed anterior or posterior subluxation of the talus at the time of removal. Three months after removal of the Ilizarov apparatus, the median DF angle was −5° However, 4 patients showed less than −15° of DF and underwent ankle arthrodesis with the ankle joint in the 5° DF position. At the final follow-up, median DF angle was 5°.ConclusionThis technique allows for safe, gradual correction of equinus deformity without talar subluxation, although additional procedures, such as ankle arthrodesis, may be needed in some cases.     

Techniques for the management of burn contractures with the Ilizarov Fixator.

The Ilizarov fixator was used to correct chronic burn deformities of the foot and ankle. These contractures can be classified as "simple" or "complex" based on associated deformities and musculoskeletal function. The simple, undirectional deformities of equinus, cavus, rockerbottom, and toe dislocations are fairly easy to correct and maintain. Correction and maintenance of complex deformities with varus or valgus angulation, bone abnormality, or muscle loss are more difficult.     

组织牵伸与有限截骨矫治成年人下肢外伤后严重马蹄内翻足畸形

目的探讨组织牵伸结合有限截骨矫治成年人下肢外伤后严重马蹄内翻足畸形的临床问题。方法 2004年6月至2009年2月共治疗17例成人足外伤后严重的马蹄内翻足畸形。Dimeglio分型：Ⅲ型,严重畸形13足;Ⅳ型,畸形非常严重4足。牵伸矫形器由胫骨外固定器和特殊形状的足部外固定器构成,在畸形状态能适应牵伸器顺利安装情况下,仅选择距下关节融合。如果畸形超出牵伸支架的可调空间,选择有限截骨三关节融合术,部分矫正足的内翻、内收畸形,至能顺利安装牵伸支架,残留的畸形通过牵伸逐渐矫正。结果治疗结束时所有病例的马蹄内翻足畸形均得到完全矫正。14例随访半年至3年,平均11个月;5足轻度复发,马蹄畸形均未大于20°,仍能跖行;踝关节活动度部分有一定改善。根据国际马蹄足畸形研究学组（ICFSG）的评分系统：优3足,良9足,可2足,差0足。结论组织牵伸结合有限截骨矫治成年人下肢外伤后严重马蹄内翻足畸形,便于外固定器的安装,更好地预防畸形复发、减少牵伸的时间,发挥Ilizarov技术的优势。