Ferreira Ricardo Cardenuto, Costa Marco Túlio, Lotti Cleber, Pistorello Lysie
Foot and Ankle Division, Orthopedics Department, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo, SP, Brazil.
Foot Ankle Orthop. 2023 Aug 14;8(3):24730114231195038. doi: 10.1177/24730114231195038. eCollection 2023 Jul.
Stiff equinocavus deformities of the foot are challenging to treat, often requiring extensive soft tissue dissection and bone removal. These procedures frequently yield suboptimal results and not infrequently amputation. Minimally invasive surgery using a circular external fixator potentially avoids the trauma to the soft tissue and may lead to improvement in outcomes and a lower amputation rate. The objective of this study was to evaluate the efficacy of minimally invasive surgery using a circular external fixator and limited soft tissue release to correct stiff equinocavus deformities.
The treatment outcome of 29 patients (31 feet) with stiff equinocavus deformities of the foot and ankle treated with minimally invasive surgery and circular external fixation were reviewed after a mean follow-up period of 63 months. Patients' demographics and cause of the deformities were recorded. Weight bearing radiographs of the foot were compared pre and postoperatively.
Outcome was satisfactory (plantigrade foot with improvement/resolution of pain) in 21 of 31 extremities, fair in 6 of 31 extremities, and poor in 4 of 31 extremities. In the majority of patients, a significant improvement in the equinocavus deformities was achieved with a statistically significant improvement in calcaneus and navicular height. Two patients with Charcot-Marie-Tooth and severely insensate feet had a poor outcome, resulting in transtibial amputation.
Minimally invasive surgery with gradual correction of neglected stiff equinocavus deformities using a modular circular external fixator is a reliable initial limb salvage strategy. Minimally invasive surgery and gradual correction of neglected severe stiff equinocavus deformities using the modular circular external fixator to gradually correct neglected severe stiff equinocavus deformities, is a safe initial limb salvage strategy which may simplify secondary procedures such as arthrodesis.
IV.
马蹄内翻足僵硬畸形的治疗具有挑战性，通常需要广泛的软组织松解和截骨。这些手术常常效果欠佳，截肢并不罕见。使用环形外固定器的微创手术可能避免对软组织的创伤，并可能改善治疗效果和降低截肢率。本研究的目的是评估使用环形外固定器和有限的软组织松解进行微创手术矫正马蹄内翻足僵硬畸形的疗效。
回顾性分析29例（31足）接受微创手术和环形外固定治疗的马蹄内翻足僵硬畸形患者的治疗结果，平均随访63个月。记录患者的人口统计学资料和畸形原因。比较术前和术后足部的负重X线片。
31个肢体中，21个肢体的治疗效果满意（足呈平足，疼痛改善/缓解），6个肢体效果尚可，4个肢体效果差。大多数患者的马蹄内翻畸形有显著改善，跟骨和舟骨高度有统计学意义的显著改善。2例患有夏科-马里-图斯病且足部严重感觉减退的患者预后较差，最终行胫骨截肢术。
使用模块化环形外固定器逐步矫正被忽视的马蹄内翻足僵硬畸形的微创手术是一种可靠的初始保肢策略。使用模块化环形外固定器逐步矫正被忽视的严重马蹄内翻足僵硬畸形的微创手术是一种安全的初始保肢策略，可能简化诸如关节融合等二期手术。
IV级。
