个体化治疗对高弓马蹄内翻足畸形的疗效分析

目的探讨个体化治疗对高弓马蹄内翻足畸形的临床疗效。方法笔者回顾性分析自2014-04—2016-02诊治的15例(24足)高弓马蹄内翻足畸形的临床资料,根据患者的发病原因和畸形的情况实施个体化治疗,行软组织手术(松解、转位和延长)、骨性手术(截骨和融合)或Ilizarov外固定架固定手术。手术前后采用美国矫形足踝协会(AOFAS)踝与后足评分系统评价足踝部功能,采用疼痛视觉模拟评分(VAS)评定疼痛改善情况,采用李克特量表评价患者主观满意度。结果全部患者均获随访6~20个月,平均13.8个月。所有患者术后切口均一期愈合,未出现切口感染。AOFAS评分术前(35.6±7.6)分,术后12个月(81.2±9.3)分,VAS评分术前(8.5±1.1)分,术后12个月(3.2±1.0)分,术后1年AOFAS评分和VAS评分较术前明显改善,差异均有统计学意义(t=14.700,P=0.010;t=-13.928,P=0.015)。末次随访疗效按AOFAS评分评定:优9例,良4例,可1例,差1例,优良率86.7%。末次随访患者主观满意度采用李克特量表评价:所有患者主观满意率86.7%。结论高弓马蹄内翻足畸形的种类多样,可合并多种足部畸形,治疗的难度较大,在临床上应根据个体的发病原因和畸形的情况有针对性选择软组织手术、骨性手术或者Ilizarov外固定架手术等联合的组合术式,实施个体化治疗,有助于矫正畸形,提高患者满意度,疗效确切。

Analysis of curative effects of individualized therapy on patients with equinovarus talipes cavus

Objective To investigate the clinical effect of individualized therapy on patients with equinovarus talipes cavus.Methods The clinical data of 24 feet from 15 patients with equinovarus talipes cavus were retrospective analyzed in our hospital from April 2014 to February 2016.According to the causes of the disease and the condition of the deformity,the patients underwent the individualized therapy,such as the soft tissue surgery(loose solution,transposition and extension),bone surgery (osteotomy and arthrodesis) or Ilizarov external fixator surgery.The outcome was assessed with American Orthopedic Foot and Ankle Society (AOFAS) comprehensive scoring system and visual analogue scale (VAS) pain score.Results All patients were followed up for 6～20 months,with an average of 13.8 months.All the incisions healed at the same time without any incision infection.The AOFAS score was (35.6±7.6) before operation,(81.2±9.3) 12 months after operation.VAS score was (8.5±1.1) before operation,(3.2±1.0) 12 months after operation.AOFAS score and VAS score one year after operation were significantly improved compared with those before operation.The differences were statistically significant(t =14.700,P =0.010,t =-13.928,P =0.015).Conclusion Equinovarus talipes cavus deformity can vary with multiple complication and the treatment is difficult.According to the causes of the disease and the condition of the deformity,the patients should receive the individualized therapy,such as the soft tissue surgery(loose solution,transposition and extension),bone surgery(osteotomy and arthrodesis) or Ilizarov external fixator surgery in the clinic.The individualized therapy can correct the deformity,increase patient satisfaction and curative effect.