Department of Orthopaedic Surgery, Institute for Rare Diseases, Guro Hospital, Korea University Medical College, 80 Guro-Dong, Guro-Gu, Seoul, 152-703, Korea.
Clin Orthop Relat Res. 2012 Jul;470(7):1992-9. doi: 10.1007/s11999-012-2289-4. Epub 2012 Feb 22.
Treatment of relapsed clubfoot after soft tissue release in children is difficult because of the high recurrence rate and related complications. Even though the Ilizarov method is used for soft tissue distraction, there is a high incidence of recurrence after removal of the Ilizarov frame owing to previous contracture of soft tissue and a skin scar.
QUESTIONS/PURPOSES: We asked (1) whether transfixation of midfoot joints by temporary K wires during the consolidation stage after short-term application of an Ilizarov frame would maintain correction of the relapsed clubfoot clinicoradiologically and (2) whether this method would reduce the rate of recurrence and related complications in patients with a skin scar from previous surgery.
We retrospectively reviewed 18 patients (19 feet) with relapsed clubfeet who underwent correction by soft tissue distraction using an Ilizarov ring fixator, between March 2005 and June 2008. The mean age of the patients was 8 ± 2 years (range, 4-15 years). K wire fixation for the midfoot joints combined with a below-knee cast were used during the consolidation stage. The minimum followup was 2 years (mean, 4.5 years; range, 2-6 years).
The average duration of frame application was 5 weeks; the mean duration of treatment was 11 weeks. At last followup, 16 of 19 feet were painless and plantigrade and only three of 19 feet had recurrence. The mean preoperative clinical American Foot and Ankle Society (AOFAS) score had increased at last followup (57 versus 81). The values of the AP talocalcaneal, AP talo-first metatarsal, and lateral calcaneo-first metatarsal angles improved after treatment. The three recurrent clubfeet were treated by corrective osteotomies and Ilizarov frame application.
This method could maintain the correction of relapsed clubfoot in children and reduce the recurrence rate and complications regardless of the presence of a skin scar owing to previous surgery.
儿童软组织松解后复发马蹄足的治疗较为困难，因为复发率高且相关并发症多。尽管伊里扎洛夫（Ilizarov）法可用于软组织牵伸，但由于先前的软组织挛缩和皮肤瘢痕，在去除伊里扎洛夫架后复发率仍较高。
问题/目的：我们提出了以下两个问题：（1）在短期应用伊里扎洛夫架固定后的巩固阶段，通过临时 K 线穿过中跗关节是否可以临床和放射影像学上维持复发马蹄足的矫正；（2）对于有先前手术皮肤瘢痕的患者，这种方法是否会降低复发率和相关并发症。
我们回顾性分析了 2005 年 3 月至 2008 年 6 月期间采用伊里扎洛夫环固定器行软组织牵伸矫正的 18 例（19 足）复发马蹄足患者。患者平均年龄为 8 ± 2 岁（4-15 岁）。在巩固阶段，采用中跗关节 K 线固定联合膝下石膏固定。最少随访 2 年（平均 4.5 年；范围 2-6 年）。
平均应用外固定架时间为 5 周；平均治疗时间为 11 周。末次随访时，19 足中有 16 足无痛且足底负重，仅 3 足复发。术前美国足踝外科协会（AOFAS）临床评分平均增加（57 分比 81 分）。治疗后后足的跟距角、跟骰角和跟骰侧位角均有改善。3 例复发的马蹄足通过矫形截骨和伊里扎洛夫架应用进行治疗。
该方法可维持儿童复发马蹄足的矫正，且无论是否存在先前手术的皮肤瘢痕，均可降低复发率和并发症。
