Ferreira Ricardo Cardenuto, Costo Marco Túlio, Frizzo Gastão Guilherme, da Fonseca Filho Fernando Ferreira
Foot Ankle Int. 2006 Apr;27(4):266-73. doi: 10.1177/107110070602700407.
This study was conducted to evaluate the corrective capability of the Ilizarov external fixator in the treatment of neglected clubfoot.
Thirty patients (38 feet) with a mean age of 19 (5 to 39) years with severe deformities and stiff feet associated with neglected clubfoot were studied. A limited soft-tissue dissection, Achilles tenotomy, and plantar fasciotomy were done. Progressive correction of the deformities was achieved through a standard setting of the Ilizarov external fixator. The device was used for 16 weeks, on average, and after removal a short-leg walking cast was used for an additional 6 weeks, followed by an ankle-foot orthosis (AFO) for 6 months.
The final outcome was scored as good (complete correction and no pain); fair (partial correction with plantigrade foot and occasional pain); or poor (nonplantigrade foot and continuous pain during walking). After a mean followup of 58 (range 12 to 107) months, the results were good in 30 feet (78.9%); fair in three feet (7.9%); and poor in five feet (13.2%). Early complications were a distal tibial fracture in one foot, dislocation of the first metatarsophalangeal joint in one foot, and arterial damage that resulted in amputation of the toes in one foot. Recurrence of the deformity was found in 19 feet (50%): 11 minor, three mild, and five severe. Spontaneous ankylosis developed in 28 feet (73.7%). Nine feet (23.7%) required arthrodesis for symptomatic arthritis of the ankle or midfoot and deformity that could not be treated with orthoses.
The Ilizarov external fixator allows simultaneous correction of all the severe foot deformities associated with neglected clubfoot with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding excessive shortening of the foot. Even in those patients in whom final corrective arthrodesis is necessary, this may be carried out with minimal bone resection, since the severe deformities of the foot and ankle have been corrected.
本研究旨在评估伊里扎洛夫外固定器治疗 neglected clubfoot 的矫正能力。
对 30 例（38 足）平均年龄 19 岁（5 至 39 岁）、伴有 severe deformities 且足部僵硬的 neglected clubfoot 患者进行研究。进行了有限的软组织松解、跟腱切断术和足底筋膜切开术。通过伊里扎洛夫外固定器的标准设置逐步矫正畸形。该装置平均使用 16 周，拆除后使用短腿行走石膏再固定 6 周，随后使用踝足矫形器（AFO）6 个月。
最终结果分为良好（完全矫正且无疼痛）；尚可（部分矫正，足能放平且偶尔疼痛）；或差（足不能放平且行走时持续疼痛）。平均随访 58 个月（范围 12 至 107 个月）后，30 足结果良好（78.9%）；3 足尚可（7.9%）；5 足差（13.2%）。早期并发症包括 1 足胫骨远端骨折、1 足第一跖趾关节脱位以及 1 足因动脉损伤导致足趾截肢。19 足（50%）出现畸形复发：11 例轻度、3 例中度、5 例重度。28 足（73.7%）出现自发关节融合。9 足（23.7%）因踝关节或中足症状性关节炎及矫形器无法治疗的畸形而需要进行关节融合术。
伊里扎洛夫外固定器能够通过最小限度的手术同时矫正与 neglected clubfoot 相关的所有严重足部畸形，降低皮肤或神经血管并发症的风险，并避免足部过度缩短。即使对于那些最终需要进行矫正性关节融合术的患者，由于足踝的严重畸形已得到矫正，也可通过最小限度的骨切除来进行手术。
