Wada Akifusa, Nakamura Tomoyuki, Urano Noriko, Kubota Hideaki, Oketani Yutaka, Taketa Mayuki, Fujii Toshio
aSaga Handicapped Children's Hospital, Saga bFukuoka Children's Hospital cUrano Orthopaedic Clinic, Fukuoka, Japan.
J Pediatr Orthop B. 2015 Mar;24(2):147-53. doi: 10.1097/BPB.0000000000000149.
Nineteen foot centralizations were performed in 14 patients with Jones type I and II tibial hemimelia. All feet showed equinovarus deformity and were treated by foot centralization by means of calcaneofibular arthrodesis. The average age of patients at the time of surgery was 1.3 years (range 0.4-3.8 years). The average follow-up postoperative period was 10.2 years (range 2.2-22.9). At the time of the final follow-up, four of the operated feet were plantigrade without secondary surgery. The remaining 15 limbs, however, required secondary surgery to treat postoperative early loss of correction and/or recurrent foot deformities such as equinus, varus and adduction, in addition to talipes calcaneal deformities, and fibular angular deformity at the fibular shortening osteotomy site. The deformities were treated either by repeat foot centralization, or fibular or calcaneal osteotomy. Careful observation for recurrence of the deformity is necessary until the distal fibular epiphysis closes, and the cartilagenous distal fibular end and calcaneus finally achieve ankyloses.
对14例Ⅰ型和Ⅱ型琼斯胫骨半肢畸形患者进行了19次足部中心化手术。所有足部均表现为马蹄内翻畸形，通过跟腓关节融合术进行足部中心化治疗。手术时患者的平均年龄为1.3岁（范围0.4 - 3.8岁）。术后平均随访期为10.2年（范围2.2 - 22.9年）。在末次随访时，4只接受手术的足部无需二次手术即可平足行走。然而，其余15条肢体除了跟骨畸形和腓骨缩短截骨部位的腓骨角畸形外，还需要二次手术来治疗术后早期矫正丢失和/或复发性足部畸形，如马蹄足、内翻和内收。这些畸形通过重复足部中心化手术或腓骨或跟骨截骨术进行治疗。在腓骨远端骨骺闭合之前，以及软骨性腓骨远端和跟骨最终实现融合之前，必须仔细观察畸形的复发情况。
