Dabash Sherif, Potter Eric, Catlett Gregory, McGarvey William
Department of Orthopedic Surgery, University of Louisville, Kentucky, USA; Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt.
Department of Orthopedic Surgery, The University of Texas Health Science Center at Houston, Texas, USA.
Strategies Trauma Limb Reconstr. 2020 Jan-Apr;15(1):28-33. doi: 10.5005/jp-journals-10080-1452.
An equinus deformity interferes with activities of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures increase surgical intervention with extensive dissections to release soft tissues. This study investigated the clinical outcomes of gradual overcorrection using a Taylor spatial frame (TSF) with tendo-Achilles lengthening (TAL) added as necessary.
This retrospective chart review evaluated patients with significant equinus treated with a TSF at a single large tertiary referral centre. Data collected included: diagnosis; patient demographics; laterality; time in frame; additional procedures; complications; degree of equinus deformity preoperatively and at every follow-up visit. Patients were followed at 1 week, 3 weeks, 6 weeks, 3 months, and 6 months intervals, and yearly thereafter.
Twenty-four patients (26 procedures) were treated with a TSF for equinus and had complete preoperative and follow-up measurements over 2 years. The angle of deformity increased from a preoperative -21.5 (range, -69.0 to -1.0) degrees to a postoperative 4.9 (range, -17.0 to 17.0) degrees ( = -4.4573, = 0.0001, = 26, Wilcoxon signed-rank test). A secondary outcome was a weak association (not statistically significant) between time in the TSF and the postoperative deformity angle. Four complications occurred during the follow-up (two pin site infections, one broken pin, and one plantar abscess). Three patients had recurrence of equinus deformity at time of last follow-up.
Using a TSF for correcting severe, fixed equinus contractures of the ankle joint is successful with minimal soft tissue-related complications. Overcorrection should be achieved in order to compensate for the loss of some dorsiflexion after frame removal. No added benefit was observed from having the frame on for a long time after correcting the deformity. Adding TAL is not necessary in all cases and required only in severe deformities of more than 25°.
Dabash S, Potter E, Catlett G, Taylor Spatial Frame in Treatment of Equinus Deformity. Strategies Trauma Limb Reconstr 2020;15(1):28-33.
马蹄足畸形会干扰日常生活活动。畸形的矫正方法从保守治疗（跟腱拉伸、矫形器）到手术治疗（鲍曼手术、斯特雷耶手术、跟腱延长术、软组织松解术）不等。严重的挛缩会增加手术干预的范围，需要广泛解剖以松解软组织。本研究调查了使用泰勒空间框架（TSF）进行逐步过度矫正并在必要时附加跟腱延长术（TAL）的临床效果。
这项回顾性病历审查评估了在一家大型三级转诊中心接受TSF治疗的重度马蹄足患者。收集的数据包括：诊断；患者人口统计学资料；患侧；佩戴框架的时间；额外的手术；并发症；术前及每次随访时的马蹄足畸形程度。患者在术后1周、3周、6周、3个月和6个月进行随访，此后每年随访一次。
24例患者（共进行26次手术）接受了TSF治疗马蹄足，并有完整的术前及2年的随访测量数据。畸形角度从术前的-21.5°（范围为-69.0°至-1.0°）增加到术后的4.9°（范围为-17.0°至17.0°）（Z = -4.4573，P = 0.0001，n = 26，Wilcoxon符号秩检验）。次要结果是TSF佩戴时间与术后畸形角度之间存在弱关联（无统计学意义）。随访期间发生了4例并发症（2例针道感染、1例钢针折断和1例足底脓肿）。3例患者在最后一次随访时出现马蹄足畸形复发。
使用TSF矫正踝关节严重、固定的马蹄足挛缩效果良好，软组织相关并发症最少。为了补偿去除框架后一些背屈功能的丧失，应实现过度矫正。畸形矫正后长时间佩戴框架未观察到额外益处。并非所有病例都需要附加TAL，仅在畸形超过25°的严重病例中需要。
达巴什S，波特E，卡特利特G，《泰勒空间框架治疗马蹄足畸形》。《创伤肢体重建策略》2020；15(1):28 - 33。
