Šponer P, Kučera T
Ortopedická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové.
Acta Chir Orthop Traumatol Cech. 2020;87(1):58-61.
Congenital cleft foot is a deformity characterised by genetic heterogeneity and a high degree of phenotypic variability. This together with its very low incidence is the reason for rather controversial opinions on the treatment. The authors present a case study of a boy with unilateral cleft foot classified as type III by Blauth-Borisch and type II by Abraham et al., who underwent a surgery at the age of 12 months. The defect was closed by rectangular soft tissue flaps, the intermetatarsal ligament connecting the first metatarsal head and the third metatarsal head was reconstructed with local fibrous tissue flap. The present hypermobility with extension position of the first ray were stabilised by the Kirschner wire inserted along the axis of the first ray from the dorsum of the talus through the middle of its head to the medial chondrogenic tarsal bones and further through the first metatarsal bone and the corrected metatarsophalangeal joint of the hallux. At the age of 6 years and 7 months, due to dynamic abductovalgus foot deformity, lengthening calcaneal osteotomy was also performed. Favourable clinical and radiographic outcomes of the used surgical technique were observed by the authors. The cleft foot as such shall be treated after a thorough evaluation of the patient and his/her necessary monitoring during the childhood. Key words: ectrodactyly, cleft foot, split hand/foot malformation.
先天性裂足是一种以遗传异质性和高度表型变异性为特征的畸形。加上其发病率极低，这就是关于其治疗存在相当多争议观点的原因。作者展示了一例单侧裂足男孩的病例研究，该病例根据布劳特 - 博里施分类为III型，根据亚伯拉罕等人的分类为II型，患儿在12个月大时接受了手术。缺损通过矩形软组织瓣闭合，连接第一跖骨头和第三跖骨头的跖间韧带用局部纤维组织瓣重建。沿第一跖骨轴线从距骨背侧经其头部中部插入至内侧软骨化跗骨，再进一步穿过第一跖骨和拇趾矫正后的跖趾关节的克氏针，稳定了当前第一跖骨在伸展位时的活动过度情况。在6岁7个月时，由于动态外展外翻足畸形，还进行了跟骨延长截骨术。作者观察到所采用手术技术取得了良好的临床和影像学效果。对于裂足本身，应在对患者进行全面评估并在儿童期对其进行必要监测后进行治疗。关键词：缺指（趾）畸形、裂足、裂手/裂足畸形
