Ilizarov外固定架联合跟骨截骨矫正痉挛性马蹄内翻足

发布时间：2018-05-26 20:52

本文选题：脑瘫 + 痉挛　；参考：《中国现代医学杂志》2017年10期

【摘要】：目的探究Ilizarov外固定架和跟骨外侧柱短缩截骨矫正痉挛性脑瘫马蹄内翻足的临床疗效。方法选取该院骨科2011年1月-2016年6月收治的痉挛性脑瘫马蹄内翻足合并跟骨内翻畸形患儿30例,共42足。住院期间均行手术治疗,术中采用跟骨外侧柱矩形截骨,跟腱延长,胫前肌外移,伊式架外固定手术,充分解决跟骨内翻畸形。术后随访观察患儿患足形态特征、功能状况及X线情况,应用国际马蹄足畸形研究学组(ICFSG)评分系统评分,回顾性分析患者的临床资料。结果所有患者的顺利完成手术,平均手术时间(178.6±42.1)min,平均术中出血量(74.8±26.3)ml,术后平均住院时间(9.7±1.5)d,所有患者均获随访,平均随访时间(23.5±3.0)个月。至末次随访未见严重感染、截骨不愈合或延迟愈合等手术相关并发症,外形及行走功能明显改善,患足背伸肌力良好。与治疗前相比,患者拆除伊氏架外固定和末次随访时患足背伸角度增加,ICFSG评分降低,差异均有统计学意义(P0.05),末次随访时改善更加显著。结论跟骨外侧柱矩形短缩截骨术可有效减少足外侧柱长度,使中足、前足内翻得到矫正,减轻跟骨内翻,增大了距下复合体的间隙,使距骨下沉,改善高弓足,达到弹性生理负重状态从而改善患儿的行走步态,是治疗痉挛性脑瘫马蹄内翻足临床效果满意的手术方式。
[Abstract]:Objective to investigate the clinical effect of Ilizarov external fixator and lateral calcaneal column shortening osteotomy in correction of spastic cerebral palsy equinovarus foot. Methods from January 2011 to June 2016, 30 cases (42 feet) of spastic cerebral palsy with calcaneal varus deformity were selected. All the patients underwent surgical treatment during the hospitalization. The lateral column of calcaneus was used for rectangular osteotomy, the Achilles tendon was lengthened, the anterior tibial muscle was removed from the outside, and the external fixation was performed with an Iraqi frame to fully resolve the calcaneal varus deformity. The clinical data of the patients were analyzed retrospectively by using the international horseshoe foot deformity study group (ICF SGS) scoring system. Results the average operation time was 178.6 卤42.1 min, the average intraoperative blood loss was 74.8 卤26.3 ml, the average hospitalization time was 9.7 卤1.5 days. All patients were followed up, the average follow-up time was 23.5 卤3.0 months. At the last follow-up, there was no serious infection, osteotomy or delayed healing and other related complications, the appearance and walking function were improved significantly, and the extensor muscle strength of the affected foot was good. Compared with before treatment, the ICFSG scores of the patients with lower ICFSG scores were significantly lower than those before the removal of the Ehrlich frame fixation and the last follow-up, and the improvement was more significant at the last follow-up. Conclusion the rectangular shortening osteotomy of lateral column of calcaneus can effectively reduce the length of lateral column of foot, correct middle foot and forward foot varus, reduce calcaneal varus, enlarge the space of subtalar complex, make talus sink and improve high arch foot. To reach the state of elastic physiological load and improve the walking gait of children is a satisfactory surgical method for the treatment of spastic cerebral palsy with equinovarus foot.
【作者单位】：山东省青岛市妇女儿童医院小儿骨科;
【基金】：山东省医药卫生科技发展计划项目(No:2015WSA02011)
【分类号】：R726.8

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