骨外固定技术治疗脊柱裂后遗足踝畸形

发布时间：2018-02-25 06:27

本文关键词： 脊柱裂下肢畸形足踝畸形骨外固定器　出处：《中国矫形外科杂志》2017年04期 　论文类型：期刊论文

【摘要】：[目的]总结骨外固定技术治疗脊柱裂足踝畸形的主要方法、优势及综合疗效。[方法]2012年3月~2016年4月,回顾性分析本科就诊并手术的脊柱裂足踝畸形248例患者,男121例,女127例;平均年龄25.5岁。左侧49例,右侧53例,双侧146例。按外固定器使用种类,使用Ilizarov外固定器115例,使用组合式外固定器107例,11例同时使用了Ilizarov外固定器+组合式外固定器。同期实施跟距关节截骨、三关节截骨、第一跖骨基底截骨、跟腱松解、胫后肌延长、跟腱固定等手术。[结果]248例患者获得近期随访,所有足踝畸形均得到有效矫正,恢复全足跖行负重,未出现外固定手术相关的神经血管损伤等并发症,针道感染5例5针道,钢针断裂1例,1例跟骨内侧针道发生热烧伤,经换药后愈合。1例发生外固定相关皮肤过敏湿疹,3例马蹄内翻足畸形调整过程中发生胫距关节前脱位,改变外固定构型后矫正。235例获得门诊和电话随访,平均随访时间28.5个月,AOFAS足踝评分平均88.7分,与术前比较,P=0.0130.05,差异具有统计学意义。依照秦泗河肢体残疾矫正的评价标准进行评价,优180足,良55足,可0足,优良率100%。[结论]骨外固定技术是治疗脊柱裂各种类型足踝畸形的有效方法,简便微创,可靠可调,可以规避严重的并发症。
[Abstract]:[objective] to summarize the main methods, advantages and comprehensive effects of external fixation in the treatment of spina bifida ankle deformity. [methods] from March 2012 to April 2016, 248 cases of spina bifida ankle deformity, including 121 males, were retrospectively analyzed. The average age of female was 25.5 years old. There were 49 cases on the left side, 53 cases on the right side and 146 cases on the bilateral side. According to the type of external fixator, 115 cases were treated with Ilizarov external fixator. Ilizarov external fixator was used in 11 cases with combined external fixator. Calcaneal joint osteotomy, triarticular osteotomy, base osteotomy of first metatarsal bone, release of Achilles tendon and lengthening of posterior tibial muscle were performed simultaneously. [results] 248 cases of Achilles tendon fixation were followed up for a short time. All the ankle deformities were effectively corrected, all the foot metatarsus were recovered with weight bearing, and there were no complications such as nerve and vascular injury associated with external fixation. 1 case with rupture of steel needle and 1 case with thermal burn of medial calcaneal needleway. After dressing change, 1 case healed and 1 case developed skin allergic eczema associated with external fixation. 3 cases occurred anterior dislocation of tibiotalar joint during adjustment of equinovarus deformity. 235 patients received outpatient and telephone follow-up after changing the external fixation configuration. The average follow-up time was 28.5 months and the average AOFAS ankle score was 88.7. The difference was statistically significant compared with that before operation. According to the evaluation criteria of Qin Sihe limb disability correction, 180 excellent, 55 good and 0 fair were evaluated. [conclusion] Extraosseous fixation is an effective method for the treatment of various types of foot and ankle deformities of spina bifida. It is simple, minimally invasive, reliable and adjustable, and can avoid serious complications.
【作者单位】：天津医科大学研究生院;国家康复辅具研究中心附属康复医院矫形外科;
【分类号】：R687.3

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