Jiao Shao-feng, Qin Si-he, Guo Bao-feng, Wang Zhen-jun, Wu Hong-fei, Pan Qi
Zhongguo Gu Shang. 2015 Feb;28(2):145-9.
To explore the surgical method and clinical curative effect of Ilizarov technique combined with limited surgical treatment for neurotrophic malnutrition equinovarus accompanied with weight-bearing area ulcer.
From July 2004 to December 2011, 21 cases of neurological disorders equinovarus with skin ulcer in weight-bearing area were treated including 14 males and 7 females with an average age of 21.3 years old ranging from 8 to 32 years. Among them,19 cases with talipes equinovarus were on account of spina bifid and 2 cases on account of spinal cord injury of lumbar sacral segment. Nine cases were on the left foot and 12 cases were right foot. The ulcer area in out-below side of the fifth metatarsal bone was in 6 cases, in basement of the fifth metatarsal bone in 5 cases,in lateral of calcaneocuboid joint 2 cases, and in lateral of subtalar joint in 8 cases. Surgical procedure included plantar medial release technique, tendo-chilles lengthenning, and three-joint partial osteotomy. During operation,the skin and soft tissue of ulcer were resected and the incision was sutured when the ulcer was in the lateral of subtalar joint, and ankle Ilizarov external fixation for extension was installed after correcting talipes equinovarus partially. For the legacy skin ulcer in weight-bearing area,the Shenrg-ji cream (Chinese characters) was used after operation for one time per day until the wound healed. Adjusting Ilizarov external fixation for correcting residual deformity until it is satisfaction. During this process weight-bearing walking was keeping.
All cases were followed up from 6 to 52 months with an average of 28 months. All ulcers were healing and no recurrence. The ulcer healing time was 14 to 36 days postoperative (26 days in average). Eighteen deformity feet were corrected satisfactorily, and recovered fully plantar foot, 3 feet appeared mild deformity after 1 year. Ankle joint activity appeared limited in 15 cases and got completely rigidity in 6 cases. The AOFAS increased from preoperative 34.0±7.2 to 86.0±8.5 postoperatively; 8 feet got excellent, 10 good,3 fair.
The clinical effect of Ilizarov technique combined with limited operation and the Sheng-ji cream in correction of the talipes equinovarus with skin ulcer in weigh-bearing area on account of neurotrophic malnutrition is satisfactory, the surgical method is simple and the treating course in security, and serious complications can be avoided.
探讨Ilizarov技术结合有限手术治疗神经营养不良性马蹄内翻足伴负重区溃疡的手术方法及临床疗效。
2004年7月至2011年12月，治疗21例伴有负重区皮肤溃疡的神经源性马蹄内翻足患者，其中男14例，女7例，平均年龄21.3岁（8～32岁）。其中，19例马蹄内翻足因脊柱裂所致，2例因腰骶段脊髓损伤所致。左侧9例，右侧12例。溃疡位于第5跖骨远侧下方6例，第5跖骨基底5例，跟骰关节外侧2例，距下关节外侧8例。手术方法包括足底内侧松解术、跟腱延长术和三关节部分截骨术。术中切除溃疡处皮肤及软组织，溃疡位于距下关节外侧时缝合切口，部分矫正马蹄内翻足后安装踝关节Ilizarov外固定延长器。对于负重区遗留的皮肤溃疡，术后使用生肌膏，每日1次，直至伤口愈合。调整Ilizarov外固定矫正残留畸形，直至满意。在此过程中保持负重行走。
所有病例随访6～52个月，平均28个月。所有溃疡均愈合，无复发。溃疡愈合时间为术后14～36天（平均26天）。18只畸形足矫正满意，足跖面完全恢复，3只足1年后出现轻度畸形。15例踝关节活动受限，6例完全僵硬。美国足踝外科协会（AOFAS）评分从术前34.0±7.2提高到术后86.0±8.5；优8足，良10足，可3足。
Ilizarov技术结合有限手术及生肌膏治疗神经营养不良性马蹄内翻足伴负重区皮肤溃疡临床效果满意，手术方法简单，治疗过程安全，可避免严重并发症。
