后足截骨结合泰勒空间外固定支架矫正严重马蹄足畸形临床研究

目的探讨后足截骨结合数字外固定支架的数字化矫正在严重马蹄足畸形中的应用效果。方法于2013年5月—2019年5月,采用后足截骨加泰勒空间外固定支架(Taylor Spatid Frame,TSF)治疗的19例严重马蹄足患者(23足),其中主要表现为马蹄畸形>40°13足;马蹄合并前、中足明显内收及内翻>20°10足。以马蹄畸形为主合并轻度内翻及旋转的患足实施后足U形截骨加标准足踝TSF构型及安装,参数测量时以距下关节前方为畸形旋转中心及起始点,以全足与胫骨对照进行矫正。马蹄合并前足内收、旋转及后足内翻,实施V形截骨。足部空间足够时,在足部及跨踝关节安装6+6串联TSF,分别以距舟关节内侧缘及距下关节前方为畸形旋转中心及起始点,同步矫正前足及马蹄畸形;足部空间狭小时,先以前足与胫骨为对照安装TSF矫正前足畸形。然后再次变换固定模式,将足与胫骨对照矫正足的马蹄及内翻畸形。结果所有病例均完成治疗,畸形矫正85%~100%,平均93.3%,无严重的并发症。获得0.5~1年随访20足,依据课题组马蹄足畸形矫正标准:优7足、良11足、可2足、差0足;依据ICFSG评分系统:优3足、良14足、可3足、差0足。结论后足截骨安装外固定支架牵伸矫正严重的马蹄足畸形能够获得较好的疗效,并发症少。应用数字外固定及数字化矫形技术,可以更加精准地矫正严重的马蹄足畸形,容易被医生掌握,是足踝外科的一个发展方向。

Clinical study on the correction of severe club-foot with hindfoot osteotomy combined with Taylor Spatial Frame

Objective To explore the application effect of digital correction of posterior foot osteotomy combined with digital external fixator in severe horseshoe deformity.Methods From May 2013 to may 2019,19 patients with severe equinovarus foot were treated with posterior foot osteotomy and TSF.13 feet were more than 40°in clubfoot deformity,10 feet were more than 20°in clubfoot adduction and varus.The U-shaped osteotomy with standard ankle TSF configuration and installation was performed on the foot with horseshoe deformity combined with slight varus and rotation.The front of subtalar joint was used as the center and starting point of deformity rotation during parameter measurement,and the whole foot and tibia were used as the control for correction.V-shaped osteotomy was performed on horseshoe with adduction,rotation of anterior foot and varus of posterior foot.When the foot space is enough,6+6 series TSF should be installed in the foot and ankle joint,and the medial margin of the scaphoid joint and the front of the subtalar joint should be taken as the center and starting point of deformity rotation respectively,so as to correct the deformity of the front foot and horseshoe synchronously;when the foot space is narrow,TSF should be installed in the front foot and tibia as the control to correct the deformity of the front foot.Then the fixation mode was changed again,and the foot and tibia were compared to correct the clubfoot and varus deformity.Results All cases were treated,and the deformity correction rate was 85%~100%,with an average of 93.3%.There were no serious complications.20 feet were followed up for 0.5~1 year.According to the correction standard of hoof deformity of our research group:excellent 7 feet,good 11 feet,fair 2 feet,and poor 0 feet.According to the ICFSG scoring system:excellent 3 feet,good 14 feet,fair 3 feet,and poor 0 feet.Conclusion The hind-foot osteotomy and external fixation can be used to correct severe club-foot deformity,which can obtain better curative effect and fewer complications.The application of digital external fixation and digital orthopedics can more accurately correct serious club-foot deformities,which are easy to be mastered by surgeons.It is the Direction of development for foot and ankle surgery.