[伊利扎洛夫技术联合有限手术矫正青少年脑瘫痉挛性马蹄内翻足]
[Ilizarov technique combined with limited surgery for correction of spastic clubfoot in adolescents with cerebral palsy].
作者信息
Gao Chunzhi, Wu Han, Xiao Peng, Wu Xuejian
机构信息
Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China.
Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Feb 15;32(2):182-186. doi: 10.7507/1002-1892.201710045.
OBJECTIVE
To evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy.
METHODS
A retrospective analysis of clinical data of 29 cases (33 feet) of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male (20 feet) and 12 were female (13 feet) with an age range from 13 to 28 years (mean, 17.6 years). According to Diméglio classification, 19 feet were rated as gradeⅡ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external fixator, and the wearing time gradually reduced to completely abandon the brace.
RESULTS
All 29 patients (33 feet) were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group (ICFSG) score (5.21±3.91) was significantly lower than the preoperative score (36.73±4.80), and the difference was significant ( =47.227, =0.000). The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness.
CONCLUSION
Ilizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with appropriate soft tissue surgery according to the patient's symptoms and signs.
目的
评估伊里扎洛夫技术联合软组织松解及肌力平衡治疗青少年脑瘫痉挛性马蹄内翻足的疗效。
方法
回顾性分析2011年6月至2016年9月符合入选标准的29例（33足）脑瘫痉挛性马蹄内翻足畸形患者的临床资料。其中男性17例（20足），女性12例（13足），年龄13～28岁，平均17.6岁。按迪梅廖分类法，Ⅱ级19足，Ⅲ级14足。所有患者均行软组织松解及肌肉平衡术，同时应用伊里扎洛夫技术矫正内翻畸形。术后5～7天开始逐渐调整外固定器，直至达到满意的足踝形态。拆除外固定器后使用矫形支具，佩戴时间逐渐减少至完全弃用支具。
结果
29例（33足）均获随访，随访时间12～22个月，平均18个月。所有患者均恢复足跖行，无针道感染及神经血管损伤。1足在拆除外固定器后6个月出现轻度畸形复发，经对症治疗后步态恢复正常。其余32足随访期间无畸形复发。末次随访时，国际马蹄内翻足研究组（ICFSG）评分（5.21±3.91）显著低于术前评分（36.73±4.80），差异有统计学意义（ =47.227， =0.000）。优27足，良3足，可3足，优良率为90.91%。患者自我评估疗效，非常满意27足，满意6足。
结论
伊里扎洛夫技术治疗马蹄内翻足有效。根据患者症状体征联合适当软组织手术，也是治疗青少年脑瘫痉挛性马蹄内翻足的可行方法。
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