Eidelman Mark, Katzman Alexander
Pediatric Orthopaedics Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
J Pediatr Orthop. 2011 Jun;31(4):429-34. doi: 10.1097/BPO.0b013e3182172392.
Treatment of foot deformities in arthrogryposis is a challenging problem. Most deformities are very rigid clubfeet, such as deformities with severe equinus, supination, cavus, hindfoot varus, and forefoot adduction. Vertical talus with severe rocker bottom is also common. Traditional approaches included casting and soft tissue release, which are usually only partially successful. We describe our experience with the treatment of arthrogrypotic foot deformities with the Taylor Spatial Frame.
Over a period of 5 years, we treated 7 patients (10 feet) with various arthrogrypotic foot deformities. There were 4 girls and 3 boys with a mean age 10.6 years (range: 4 to 16 y). Six patients had clubfoot deformities and 1 had vertical talus. All patients had previous surgeries, including soft tissue release in 8 feet and Ilizarov correction in 3 feet. Three patients underwent bilateral correction, 3 patients underwent midfoot osteotomies, and 2 patients had supramalleolar osteotomies and lengthening to compensate for growth arrest of the distal tibia. The remaining feet had correction of their deformities by soft tissue distraction. Six patients underwent correction using a Butt frame and 5 by standard frame configuration.
All patients achieved the preoperative correction goal and their frames were removed at an average of 16.1 weeks (range: 14 to 18 wk). Complications included pin tract infections in 4 patients. One patient had iatrogenic regenerate translation that was reduced by a residual program, 1 patient had recurrence of equines, and another had partial recurrence of forefoot supination. Two hindfoot varus deformities were successfully treated by calcaneal osteotomy at the time of Butt frame removal.
On the basis of our preliminary experience, we believe that the Taylor Spatial Frame is a reliable and accurate method of correction of complex foot deformities in children with arthrogryposis.
先天性多发性关节挛缩症足部畸形的治疗是一个具有挑战性的问题。大多数畸形为非常僵硬的马蹄内翻足，例如伴有严重马蹄足、内旋、高弓足、后足内翻和前足内收的畸形。伴有严重摇椅底畸形的垂直距骨也很常见。传统方法包括石膏固定和软组织松解，通常仅部分成功。我们描述了使用泰勒空间框架治疗先天性多发性关节挛缩症足部畸形的经验。
在5年的时间里，我们治疗了7例（10足）患有各种先天性多发性关节挛缩症足部畸形的患者。其中有4名女孩和3名男孩，平均年龄10.6岁（范围：4至16岁）。6例患者患有马蹄内翻足畸形，1例患有垂直距骨。所有患者均曾接受过手术，其中8足进行过软组织松解，3足进行过伊里扎洛夫矫正。3例患者接受了双侧矫正，3例患者进行了中足截骨术，2例患者进行了内踝上截骨术并延长以补偿胫骨远端生长停滞。其余足部通过软组织牵张矫正畸形。6例患者使用对接框架进行矫正，5例患者使用标准框架配置进行矫正。
所有患者均达到术前矫正目标，平均16.1周（范围：14至18周）拆除框架。并发症包括4例患者出现针道感染。1例患者发生医源性再生移位，通过残余程序复位；1例患者马蹄足复发，另1例患者前足内旋部分复发。在拆除对接框架时，通过跟骨截骨术成功治疗了2例后足内翻畸形。
基于我们的初步经验，我们认为泰勒空间框架是矫正先天性多发性关节挛缩症患儿复杂足部畸形的一种可靠且精确的方法。
