组合性手术治疗脊柱裂后遗踝足畸形

目的:探讨脊柱裂后遗踝足畸形的外科治疗策略以及不同踝足的畸形手术组合方法及其疗效。方法:回顾性分析1990年1月至2009年7月收治的107例脊柱裂后遗踝足部畸形患者的病例资料。其中男44例,女63例;年龄1.3～52岁,平均17.7岁;双踝足畸形58例,单侧49例(左侧22例,右侧27例)。马蹄足畸形类99足,行跟腱延长及肌腱移位术;跟行足畸形类25足,行踝前肌腱松解及肌腱移位术;内外翻足畸形类17足,行肌腱移位及跟骨截骨术;连枷足畸形15足,行跟距关节融合及跟腱短缩术;爪形趾畸形9足,行趾间关节融合或Ilizarov技术牵拉矫正。采用AOFAS综合评分系统从主观疼痛感觉、客观功能检查等方面评定疗效。结果:107例中79例127足获得随访,时间48～180个月,平均64个月。根据AOFAS综合评分系统,结果优89足,良26足,中9足,差3足。结论:脊柱裂踝足畸形外科治疗策略包括矫正畸形、平衡肌力、稳定关节和保留足的弹性4个基本原则。针对不同类型足畸形,采用相应的组合性手术方案进行治疗,不但可以有效的矫正畸形,而且能改善患者的行走功能,获得满意的疗效。

Combined procedure for the treatment of ankle and foot deformities secondary to spina bifida

Objective:To study surgical strategies for ankle and foot deformities secondary to spina bifida and treatment methods for different types of deformities. Methods:From January 1990 and July 2009,107 patients with ankle and foot deformities secondary to spina bifida were retrospectively analyzed. There were 44 males and 63 females,with an average age of 17.7 years(rangd from 1.3 to 52 years). Among the patients,58 patients had double ankle deformities,49 patients had unilateral deformities(22 cases on the left side,27 cases on the right). Ninety-nine patients with equinus deformities were treated by achilles tendon lengthening and tendon transfering;25 patients with talipes were treated by release of anterior tendon of ankle and tendon transfer;17 patients with valgus and varus deformities were treated by tendon transfer and calcaneal osteotomy;15 patients with flail deformities were managed treated by bone fusion between calcaneus and talus and shortening of achilles tendon; 9 patients with claw toe deformities were treated by bone fusion of interphalangeal joint or Ilizarov's distraction. AOFAS(American Orthopaedic Foot & Ankle Society)comprehensive scoring system was used to evaluate subjective pain and objective functional. Results:Seventy-nine(127 feet) of 107 patients were followed up,and the duration ranged from 48 to 180 months( averaged,64 months). According to AOFAS scoring system,the results were rated as excellent in 89 feet,good in 26 feet,moderate in 9 feet and poor in 3 feet. Conclusion:Treatment strategies for ankle-foot deformities mainly included four principles,deformity correction,muscular balance,joint stability and reservation of foot elasticity. Different combined procedure was applied for different foot deformities and received good therapeutic effects.