应用Ilizarov技术治疗儿童复发性僵硬型先天性马蹄内翻足

目的探讨应用Ilizarov技术治疗复发性僵硬型先天性马蹄内翻足(Congenital Clubfoot,CCF)的方法与临床疗效。方法自2008年1月至2015年12月,应用Ilizarov技术治疗29例45足复发性僵硬型CCF,依据Dimeglio分型,均为Ⅲ、Ⅳ型,将连接于胫骨、跟骨,跖骨的Ilizarov外固定环互相连接、组合成复杂的三维外固定器,通过四维调节(三维空间加一维时间),逐渐矫正畸形,从而使患足达到或接近正常足的外形和功能。其中,31足单纯安装Ilizarov外固定牵伸器,9足结合经皮跟腱延长,7足结合中跗骨截骨,3足结合后足的V形截骨。术后7天开始矫正,速度1 mm/d,分4次完成,踝关节矫正至背伸约10°,后足轻度外翻后,停止矫形。矫正位带外固定器负重或保护下行走4周,拆除外固定器短腿管型石膏固定6~8周,拆石膏后夜间支具维持矫形3年。结果所有患者均获随访,随访时间11个月至6年,平均39个月。根据国际马蹄足畸形研究会(ICFSG)的评分系统,优23足,良18足,可3足,差1足,优良率91%。差的1足为DimeglioⅣ型,单纯应用Ilizarov外固定牵伸器治疗,矫形后步态改善,但遗留部分跟骨内翻畸形,2年后畸形明显复发,行三关节融合术治愈。结论应用llizarov外固定器三维矫正马蹄内翻足畸形,安全、微创、疗效确实,尤其适用于大年龄儿童之复发性僵硬型马蹄内翻足,有一定的临床应用价值。

Treatment of recurrent rigid congenital clubfoot with Ilizarov technique

Objective To explore the clinical efficacy of llizarov technique in the treatment of recurrent rigid congenital clubfoot (CCF). Methods From January 2008 to December 201 5,Ilizarov technique was employed for treating 45 feet of 29 patients with recurrent rigid CCF.According to the Dimeglio classification, the clinical types wereⅢandⅣ.Through connections to tibia and calcaneus,metatarsal Ilizarov external fixa-tion ring could correct deformity gradually via four-dimensional adjustment (three-dimensional space plus one-dimensional time)so that normal foot shape and functionality were restored.The interventions included Ilizarov external fixator (31 feet),percutaneous Achilles tendon extension (9 feet),tarsal bone osteotomy (7 feet) and hind foot V-shaped osteotomy (3 feet).At Day 7 post-correction,the daily speed was 1 mm per day and it was completed 4 times.Ankle correction lasted until dorsal extension of around 1 0°and mild foot valgus.Or-thotopic fixation with external fixator or loaded walking for 4 weeks,short-leg cast plaster immobilized for 6 weeks after removing plaster cast and orthopedic worn for 3 years. Results The mean follow-up period was 39 (1 1 ~72)months.According to the International Society of clubfoot deformities (ICFSG)scoring system,the outcomes were excellent (23 feet),good (1 8 feet),decent (3 feet)and poor (1 foot,DimeglioⅣ).The ex-cellent rate was 91%.Early application of Ilizarov external fixation improved post-orthopedic gait.Calcaneal varus deformity persisted after 2 years.And it was cured by Triple Arthrodesis. Conclusions The application of llizarov external fixator is safe,mini-invasive and effective for three-dimensional correction of clubfoot de-formity.Especially is indicated for recurrent and rigid clubfoot of elder children.