外固定器治疗脑性瘫痪僵硬性足部畸形216足疗效分析

发布时间：2018-03-25 21:15

本文选题：Ilizarov外固定器　切入点：足部畸形　出处：《中国矫形外科杂志》2017年01期

【摘要】：[目的]观察外固定器治疗脑性瘫痪僵硬性足部畸形的临床效果,探讨脑性瘫痪足部畸形外科矫正和功能重建的新技术。[方法]回顾性分析1988年10月~2013年3月165例脑性瘫痪僵硬性足部畸形患者,236足,根据足部畸形的特征,设计不同构型的外固定器。上运动神经元损伤型足部畸形主要实施选择性脊神经后根切断术、选择性胫神经缩窄手术和距下关节外融合手术或距下关节融合术,同时安装外固定器。下运动神经元损伤型足部畸形主要实施软组织松解、肌腱转位术或截骨手术,同时安装外固定器。[结果]154例216足获得至少3年以上随访,马蹄内翻足64足,马蹄足70足,马蹄外翻足82足。其中上运动神经元损伤型足部畸形62足,下运动神经元损伤型足部畸形154足。佩戴外固定器时间8~13周,平均10周。采用Laaveg-Ponseti足功能评分系统:优88足,良78足,可34足,差16足,优良率76.9%。第一次术后复发14足,复发率6.5%。钉道感染32足,清理炎性分泌物或更换钉道位置后治愈。足跟部皮肤坏死、足底部软组织坏死和跟骨慢性骨髓炎1例,彻底清创和腓肠神经营养血管皮瓣转移后治愈。踝关节骨性关节炎1例,踝关节融合后治愈。[结论]外固定器治疗脑性瘫痪僵硬性足部畸形符合生物学重建理论,可提高疗效,减少并发症。
[Abstract]:[objective] to observe the clinical effect of external fixator in the treatment of inflexible foot deformity of cerebral palsy. To discuss the new technique of surgical correction and functional reconstruction of cerebral palsy foot malformation. [methods] 165 patients with rigid foot malformation of cerebral palsy from October 1988 to March 2013 were analyzed retrospectively. Different types of external fixators were designed. Selective posterior rhizotomy, selective tibial nerve constriction, subtalar extraarticular fusion or subtalar arthrodesis were performed for upper motor neuron injury foot deformity. The soft tissue release, tendon transposition or osteotomy were performed at the same time. [results] 154 cases 216 feet were followed up for at least 3 years, and 64 feet with equinovarus varus equinovarus were followed up at least 3 years. 70 feet of horseshoe, 82 feet of equinovarus valgus, 62 feet of upper motor neuron injury foot deformity, 154 feet of inferior motor neuron injury foot malformation. The time of wearing external fixator was 813 weeks. Average 10 weeks. Laaveg-Ponseti foot function scoring system was used: excellent 88 feet, good 78 feet, fair 34 feet, poor 16 feet, excellent and good rate 76.9.The recurrence rate was 6.5% and recurrence rate was 6.5%. 1 case with skin necrosis of heel, soft tissue necrosis of the base of foot and chronic osteomyelitis of calcaneus, 1 case cured after thorough debridement and sural neurovascular flap transfer, 1 case of ankle osteoarthritis, 1 case of ankle osteoarthritis, 1 case of ankle osteoarthritis, 1 case of complete debridement and sural neurovascular flap transfer. [conclusion] the treatment of inflexible foot deformity of cerebral palsy with external fixator accords with the theory of biological reconstruction, which can improve the curative effect and reduce complications.
【作者单位】：郑州大学第一附属医院骨科;国家康复辅具研究中心附属康复医院骨科;
【基金】：国家十二五科技支撑计划基金资助项目(编号:2012BAI33B06)
【分类号】：R658.3

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