使用伊利扎洛夫外固定器不进行软组织松解来矫正严重、僵硬的马蹄足畸形。
Use of Ilizarov External Fixation Without Soft Tissue Release to Correct Severe, Rigid Equinus Deformity.
作者信息
Jeong Bi O, Kim Tae Yong, Song Wook Jae
机构信息
Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
出版信息
J Foot Ankle Surg. 2015 Sep-Oct;54(5):821-5. doi: 10.1053/j.jfas.2014.12.039. Epub 2015 May 23.
The purpose of the present retrospective study was to report the correction of severe, rigid equinus deformities using an Ilizarov external fixator alone, without adjunctive open procedures. Ten feet in 10 patients with rigid equinus deformities were enrolled and underwent gradual correction using an Ilizarov external fixator alone, without additional open procedures. The range of ankle joint motion was measured preoperatively and at the last follow-up visit. The radiographic outcome was assessed using the lateral tibiotalar angle on ankle radiographs taken preoperatively, immediately after removal of the Ilizarov fixator, and at the last follow-up visit. The mean duration of external fixator treatment was 40.1 ± 13.5 days. The preoperative mean ankle range of motion was -55.5° ± 22.2° of dorsiflexion and 63.0° ± 20.8° of plantarflexion. At the last follow-up visit, the mean dorsiflexion had increased to -2.5° ± 6.8° and the mean plantarflexion had decreased to 30.5° ± 12.6°. The mean lateral tibiotalar angle was 152.9° ± 19.7° preoperatively, 103.9° ± 9.4° immediately after removal of the Ilizarov external fixator, and 113.9° ± 11.6° at the last follow-up visit. Immediately after fixator removal, all the patients had clinical correction of their deformity to a plantigrade foot using the Ilizarov external fixator alone, with a mean correction of 49.0° ± 17.4°. Some recurrence was noted at the last follow-up examination, with a final mean correction of 39.0° ± 18.0°. The present study has demonstrated successful correction of severe, rigid equinus deformity with the use of an Ilizarov external fixator without the need for adjunctive soft tissue procedures. This method can be effective for patients with a high risk of complications after open procedures owing to their poor soft tissue envelope.
本回顾性研究的目的是报告仅使用Ilizarov外固定器矫正严重、僵硬的马蹄足畸形,而不进行辅助开放性手术的情况。纳入10例患有僵硬马蹄足畸形的患者的10只足,仅使用Ilizarov外固定器进行逐步矫正,未进行额外的开放性手术。在术前和最后一次随访时测量踝关节活动范围。使用术前、Ilizarov固定器拆除后即刻以及最后一次随访时拍摄的踝关节X线片上的胫距外侧角评估影像学结果。外固定器治疗的平均持续时间为40.1±13.5天。术前踝关节活动范围的平均值为背屈-55.5°±22.2°,跖屈63.0°±20.8°。在最后一次随访时,平均背屈增加到-2.5°±6.8°,平均跖屈减少到30.5°±12.6°。术前胫距外侧角的平均值为152.9°±19.7°,Ilizarov外固定器拆除后即刻为103.9°±9.4°,最后一次随访时为113.9°±11.6°。固定器拆除后即刻,所有患者仅使用Ilizarov外固定器就实现了畸形的临床矫正,达到了平足,平均矫正角度为49.0°±17.4°。在最后一次随访检查时发现有一些复发,最终平均矫正角度为39.0°±18.0°。本研究表明,使用Ilizarov外固定器无需辅助软组织手术即可成功矫正严重、僵硬的马蹄足畸形。对于因软组织条件差而开放性手术后并发症风险高的患者,这种方法可能有效。