Ilizarov技术矫治僵硬型先天性马蹄内翻足畸形

目的探讨应用Ilizarov技术矫治僵硬型先天性马蹄内翻足畸形的手术方法及疗效。方法 2009年1-11月根据Ilizarov张力-应力法则,应用改良的外固定矫形器治疗先天性马蹄内翻足畸形11例14足。本组5例同期实施足跗骨的有限截骨术;6例实施跖腱膜松解术;2例实施足部肌腱转移的肌力平衡术：所有病例均实施跟腱延长术。遵循Ilizarov穿针固定的基本原则,安装具有三维矫形功能的踝足关节矫形器。术后7 d开始旋转相应的螺纹牵伸杆,逐渐矫正足内翻、内收和下垂畸形并适当过牵,使畸形得到良好的矫正。结果 11例患者术后均获得随访,随访时间6~14个月,平均11个月。畸形足均获得满意的矫正和足底持重,行走功能良好,患者满意。结论 Ilizarov技术矫治僵硬型先天性马蹄内翻足畸形,具有微创、操作简单、安全并能早期活动的优点,疗效满意。

Clinical study on Ilizarov technique in the correction of the severe rigid congenital clubfoot deformity

Objective To explore the clinical efficiency and operative methods of Ilizarov technique in the correction of the severe rigid congenital clubfoot deformity.Methods From January 2009 to December 2009,11 patients were corrected with QIN Si-he＇s orthotics equinovarus according to the Ilizarov＇s principle of tension-stress,which involved 8 males and 3 females,whose average age was 21years old（ranged from 6 to 32 years）.The limited osteotomy were performed in 5 patients,release of plantar fascia in 6 patients and dynamic muscle balance operation in 2 patients.All these patients＇ achilles tendon was lengthened.According to the principles of Ilizarov,the wires were inserted and the fixator installed,the distraction devices of the ankle and foot joint which had corrective function in three-dimensional directions were applied to the tibia and foot.The telescopic rods on the apparatus were rotated one week after the operation,The deformity of talipes equinovarus,internal rotation and the drooping of the forefoot were gradually corrected.X-ray films were taken regularly to observe the ankle joint and avoid its dislocation.The patients were encouraged to have weight-bearing during the treatment period.Results All the 11 patients were available at follow-up with a mean duration of 11 months（ranged fron 6 months to 14 months）.All patients had a satisfactory correction of the deformity with good walking on the whole foot.Conclusion Ilizarov technique for treatment of the severe rigid congenital clubfoot deformity is minimally invasive、simple and safe method.It has also the advantages of early activity and recent results is satisfactory.Combined with limited operation Ilizarov technique can correct severe,recurrence and refractory clubfoot deformity.It is an effective approach for the treatment of various kinds of rigid food anomaly and recommended extensive application in clinic.