Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea.
Clin Orthop Relat Res. 2011 Mar;469(3):860-7. doi: 10.1007/s11999-010-1497-z. Epub 2010 Aug 6.
The treatment of rigid equinocavovarus foot deformities caused by neurologic disorders is often difficult and relapse is common.
QUESTIONS/PURPOSES: We asked whether the Ilizarov technique could be used for correction of neurologic equinocavovarus foot deformities resulting in improved foot and ankle function and patient satisfaction.
The neurologic equinocavovarus foot deformities of 26 patients (mean age, 18.7 years; 29 feet) were treated using the Ilizarov technique. Nine feet were treated by distraction histiogenesis only with limited soft tissue release, whereas 20 feet needed additional osteotomy and/or tendon transfer/lengthening. Minimum followup was 12 months (mean, 72.9 months; range, 12-155 months).
The mean time required for deformity correction was 27.1 days (range, 14-47 days) and the mean time for stabilization in the apparatus was 23.2 days (range, 7-53 days). A painless, stable, and plantigrade result was obtained by 22 patients (24 feet). Mild residual foot deformity was observed in the remaining five feet of four patients. Six patients (six feet) experienced postoperative complications. Three patients (four feet) experienced recurrence of the deformity requiring surgical correction.
Ilizarov soft tissue distraction with or without callotasis of tarsal bone(s) allows a greater degree of correction of neurologic equinocavovarus foot deformities. However, to reduce the risk of recurrence after fixator removal, it may be necessary to overcorrect the deformity while in the fixator, to use nighttime splinting, and most importantly, to eliminate neuromuscular imbalance, if necessary, by combining arthrodesis with or without tendon transfer.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
神经病变引起的僵硬马蹄内翻足畸形的治疗往往较为困难，且易复发。
问题/目的：我们想知道伊里扎洛夫技术是否可用于矫正神经源性马蹄内翻足畸形，从而改善足踝功能并提高患者满意度。
采用伊里扎洛夫技术治疗 26 例（平均年龄 18.7 岁；29 足）神经源性马蹄内翻足畸形患者。9 足仅采用组织牵张成骨法治疗，仅行有限的软组织松解，而 20 足需要额外的截骨和/或肌腱转位/延长。所有患者的随访时间均至少为 12 个月（平均 72.9 个月；范围 12-155 个月）。
畸形矫正的平均时间为 27.1 天（范围 14-47 天），固定架稳定的平均时间为 23.2 天（范围 7-53 天）。22 例患者（24 足）获得无痛、稳定且足底承重的结果。4 例患者的其余 5 足仍存在轻度残余足畸形。6 例患者（6 足）发生术后并发症。3 例患者（4 足）出现畸形复发，需要再次手术矫正。
伊里扎洛夫软组织牵张术加或不加跗骨骨切开术可更大程度地矫正神经源性马蹄内翻足畸形。但是，为了降低固定器去除后复发的风险，在固定器中可能需要过度矫正畸形，夜间使用支具，最重要的是，如果有必要，通过融合术结合或不结合肌腱转位来消除神经肌肉失衡。
IV 级，治疗性研究。有关证据等级的完整描述，请参见作者指南。
