Lamm Bradley M, Ernst Jordan J, Hammouda Ahmed I, Gesheff Martin G
Chief of Foot & Ankle Surgery, Director, Foot & Ankle Deformity Center, Director, Foot & Ankle Deformity Correction Fellowship, The Paley Institute at St. Mary's Hospital and Palm Beach Children's Hospital, West Palm Beach, FL.
Foot and Ankle Deformity Correction Fellow, The Paley Institute at St. Mary's Hospital and Palm Beach Children's Hospital, West Palm Beach, FL.
J Foot Ankle Surg. 2020 Jul-Aug;59(4):863-868. doi: 10.1053/j.jfas.2019.05.011. Epub 2020 May 7.
Given their severity and resultant loss of function, postpoliomyelitic foot and ankle deformities require a unique correction method. Correction with dynamic Ilizarov external fixation is one such modality, although it is technically demanding and requires precise preoperative planning. In our case study, a 40-year-old male with a severe postpoliomyelitic equinocavovarus right foot and ankle deformity was treated with gradual correction using dynamic, hinged Ilizarov external fixation. The external fixation was in place for a total of 103 days, with gradual correction performed in 2 successive steps, achieving a functional, plantigrade foot. We maintained this position in a short leg cast for 30 days, followed by bracing and physiotherapy for 6 months. More than 2 years after the index surgery, the patient had achieved a painless and plantigrade foot, allowing for functional ambulation. This method does not require osteotomies, ankle arthrodesis, or tendon transfer.
鉴于小儿麻痹后遗症所致的足部和踝关节畸形严重且会导致功能丧失，需要采用独特的矫正方法。动态伊里扎洛夫外固定矫正术就是其中一种方式，尽管该技术要求较高且需要精确的术前规划。在我们的病例研究中，一名40岁男性患有严重的小儿麻痹后遗症右足和踝关节马蹄内翻畸形，采用动态铰链式伊里扎洛夫外固定进行逐步矫正治疗。外固定共持续103天，分两个连续步骤进行逐步矫正，最终获得了功能良好的足底着地的足部形态。我们用短腿石膏将此位置固定30天，随后进行6个月的支具固定和物理治疗。初次手术后两年多，患者的足部已无痛且足底着地，能够进行功能性行走。这种方法无需截骨、踝关节融合或肌腱转移。
