Kirienko A, Gradov L, Malagoli E, Tacci F, Lucchesi G
Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy.
Department of Orthopaedics, Galilee Medical Center, Nahariya, Israel.
J Foot Ankle Surg. 2022 Nov-Dec;61(6):1209-1220. doi: 10.1053/j.jfas.2022.02.005. Epub 2022 Feb 15.
Many authors consider the Ilizarov method as the best choice for correction of complex multiplanar foot deformities. Fifty-one patients, for a total of 55 feet, underwent V or Y osteotomy (respectively 32 and 23), 12 were due to congenital clubfoot outcomes, 11 were from post-traumatic pathologies, 9 from hemimelia, 7 from Charcot-Marie-Tooth, 5 from poliomyelitis, 3 from spina bifida, 2 from myopathy, 2 from poly-epiphyseal dysplasia, 1 from achondroplasia, 1 from arthrogryposis, 1 patient from Charcot's foot and 1 rheumatoid arthritis. All patients were contacted to undergo AOFAS and EQ-5D-5L questionnaire. The mean distraction time was 74.0 days (±25.3) and it was longer for V osteotomy (63.1 ± 21.1 vs 81.8 ± 25.4 days for Y and V respectively, p = .006). The average fixation time was 97.9 days (± 61.2), 90 days in the Y and 103 days in the V osteotomy groups. The mean preoperative foot length was longer in the group of Y osteotomy patients (158.7 ± 21.3 mm vs 133.5 ± 21.6 mm, p < .001). The mean length postoperatively was substantially the same (Y group 164.0 mm vs V group 167.4 mm, p < .562). The V osteotomy produces an elongation ratio of 440% with respect to that produced from the Y osteotomy (ratio length/distraction V/Y 0.44/0.1), with only 19% more in the distraction days. (81.8 V group vs 63.1 Y group). While the V osteotomy allows a lengthening of about 27%, the Y osteotomy, despite having correction potential superimposable to the V osteotomy, minimizes the elongation component.
许多作者认为伊里扎洛夫方法是矫正复杂多平面足部畸形的最佳选择。51例患者，共55只脚，接受了V形或Y形截骨术（分别为32例和23例），其中12例是先天性马蹄内翻足的结果，11例来自创伤后病变，9例来自半侧肢体发育不全，7例来自遗传性运动感觉神经病，5例来自小儿麻痹症，3例来自脊柱裂，2例来自肌病，2例来自多骨骺发育不良，1例来自软骨发育不全，1例来自关节挛缩症，1例患者患有夏科氏足，1例患有类风湿性关节炎。所有患者均接受了美国足踝外科协会（AOFAS）和EQ-5D-5L问卷的调查。平均牵张时间为74.0天（±25.3），V形截骨术的时间更长（Y形和V形截骨术分别为63.1±21.1天和81.8±25.4天，p = 0.006）。平均固定时间为97.9天（±61.2），Y形截骨术组为90天，V形截骨术组为103天。Y形截骨术患者术前足部平均长度更长（158.7±21.3毫米对133.5±21.6毫米，p <0.001）。术后平均长度基本相同（Y形组为164.0毫米，V形组为167.4毫米，p <0.562）。V形截骨术相对于Y形截骨术产生的伸长率为440%（长度/牵张V/Y比为0.44/0.1），牵张天数仅多19%。（V形组81.8天对Y形组63.1天）。虽然V形截骨术可实现约27%的延长，但Y形截骨术尽管具有与V形截骨术相当的矫正潜力，但可将伸长成分降至最低。
