关节外距下关节固定术治疗痉挛性双瘫扁平足临床疗效分析

目的：介绍应用关节外距下关节固定术治疗痉挛性双肢瘫患儿扁平外翻足畸形的手术指征和方法，对临床疗效及结果作出评价，并讨论其矫正机制和矫形效果。方法2011年4月至2013年6月我科采用关节外距下关节固定术技术治疗痉挛性双肢瘫患儿28例（46足），并根据畸形的程度给予相应的软组织重建手术。术后根据美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝-后足功能评分，从疼痛、功能、对线三方面评价患儿临床效果，同时观察患儿足外翻的影像学指数的改变，比较前后位片距骨-第一跖骨角和距跟角，正侧位距骨-第一跖骨角（Meary角）、跟骨倾斜角和跟骨-第一跖骨角（Hibbs’角）的变化。结果所有患儿术后平均随访2年8个月，所有患儿骨性愈合并且畸形没有复发。采用AOFAS踝-后足功能评分标准评价临床结果，平均得分88分，28足优，18足良。影像学评价测定术前及术后随访时足负重前后位的距跟角、正侧位Meary角及Hibbs’角比较，差异均有统计学意义（均P<0.05）。结论关节外距下关节固定术治疗痉挛性双肢瘫患儿扁平外翻足畸形疗效确切，后足外翻术后的指数和距下关节稳定性得到明显改善。目前本研究仅为中短期的观察，还需要长期的随访观察。

The clinical analysis of extraarticular subtalar arthrodesis for pes planovalgus in patients with spastic diplegia

Objective To introduce the surgical indication and procedures of extraarticular subtalar arthrodesis for pes planovalgus in patinents with Spastic diplegia, and to evaluate the clinical curative effects and outcomes. Methods From April 2011 to June 2013, 28 cases (46 feet) with Spastic diplegia were treated with extraarticular subtalar arthrodesis. Accoding to the degree of deformity, soft tissue reconstruction operation was given. According to AOFAS Ankle?Hindfoot Scale system, the pain, function and alignment were evaluated. The variation of imaging index on talocalcaneal angle, the talo?1st metatarsal and the calcaneal pitch angle were observed. Results The mean follow?up period was 2 years and 8 months. The effectiveness of surgery was judged by evaluating ankle and hindfoot function using AOFAS Ankle?Hindfoot Scale system. The average score of the patients was 88. The ankle and hindfoot function was excellent in 28 feet and good in 18 feet. Satisfied orthopedic effects on the talocalcaneal angle, the talo?1st metatarsal and the calcaneal pitch were confirmed during the follow?up period. Conclusion Extra?articular subtalar arthrodesis is effective for the pes planovalgus in Spastic diplegia patients. The index after operation is reliably corrected. However, longer?term observation will be needed.