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。

Tissue distraction and limited ostectomies for correcting the post-traumatic severe talipes equinovarus in the adults

Objective To explore some clinical problems of severe talipes equinovarus in the adults with post-traumatic lower extremities corrected by tissue distraction combined with limited ostectomies.Methods Between June 2004 and February 2009,17 clubfeet of 17 patients in post-traumatic lower extremities were corrected.According to the Dimeglio＇s classification：13 feet were graded as severe（gradeⅢ）,and 4 were very severe（gradeⅣ）.The distraction orthopaedic apparatus was composed of tibial frame and foot frame,while the deformities were able to adapt to distraction apparatus attachment,the subtalar fusion was only performed.If the apparatus couldn＇t be well attached to the severe deformity foot through adjusting the frames,the operative procedure of limited ostectomies and triple arthrodesis should be selected, for correcting the foot varus and adductus and installing the frames conveniently.The residual deformities were gradually corrected by tissue distraction.Results All patients＇ clubfoot were completely corrected over treatment.Final- ly,14 patients were followed up for an average duration of 11 months（range 6-36）.Five feet had mild recurrent deformities with equines20°and a plantigrade foot.Some patients obtained a more mobile foot.The final outcome was assessed using the International Clubfoot Study Group（ICFSG） score：3 feet were excellent,9 were good,2 were fair,and no poor.Conclusion Tissue distraction combined the limited ostectomies for correcting severe talipes equinovarus in the adult post-traumatic lower extremities contribute to easy attachment of the external fixator and prevention of the deformity recurrence and the superiorities of Ilizarov＇ technique.