Wu Tianyi, Chen Yixuan, Li Guangyi, Miu Yu, Shi Zhongmin
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Aug 15;39(8):982-988. doi: 10.7507/1002-1892.202505005.
To evaluate the effectiveness of correcting post-traumatic equinovarus deformity using Ilizarov external fixation technique combined with limited osteotomy.
A retrospective analysis was conducted on clinical data from 29 patients with post-traumatic equinovarus deformity treated between July 2018 and March 2023. The cohort included 18 males and 11 females, with ages ranging from 15 to 57 years (mean, 24.3 years). All patients exhibited ankylosed ankle joints with equinovarus deformity. During surgery, external fixators were installed according to Ilizarov pinning principles, and minimally invasive osteotomy was performed at the ankle joint. Concurrently, soft tissue release was achieved via minimally invasive Achilles tendon lengthening. Postoperatively, multiplanar deformity correction was accomplished through gradual adjustment of the external fixator. The fixator was removed after bony union at the osteotomy site, followed by bracing. The surgical duration, intraoperative blood loss, fixator wear time, and complications were recorded. Postoperative outcomes included assessment of deformity correction and bony union at the osteotomy site. Functional improvement and pain relief were evaluated using pre- and post-operative scores from the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score.
All 29 patients were followed up 12-24 months (mean, 18 months). The mean surgical duration was 85.6 minutes, with a mean intraoperative blood loss of 110 mL. Full deformity correction was achieved within 26-80 days (mean, 40.7 days) through progressive fixator adjustments. At correction completion, all ankles restored to a neutral or 5°-10° dorsiflexed position with plantigrade foot function. Superficial pin tract infections occurred in 3 patients (10.3%), resolved with local wound care, enhanced nursing, and oral antibiotics. No deep or systemic infections was observed. One patient sustained a calcaneal half-pin fracture due to a fall during fixator wear, but no bone fragment displacement occurred. No vascular or neurological complication was reported. Complete bony union was achieved at all osteotomy sites without nonunion. At last follow-up, the AOFAS ankle-hindfoot score improved from preoperative 42.7±8.7 to postoperative 65.7±9.3, and the VAS score decreased from preoperative 4.5±1.3 to postoperative 2.5±1.1, with significant differences ( <0.05). Functional outcomes were rated as excellent in 14 cases, good in 13 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 93.1%.
The progressive correction strategy combining Ilizarov external fixation technique with limited foot osteotomy effectively corrects post-traumatic equinovarus deformity while preserving soft tissue integrity. This method is associated with minimal, largely controllable complications and achieves alignment stability and fusion outcomes comparable to traditional open surgery, making it an effective treatment for complex foot and ankle deformities.
评估采用伊里扎洛夫（Ilizarov）外固定技术联合有限截骨术矫正创伤后马蹄内翻畸形的有效性。
对2018年7月至2023年3月期间治疗的29例创伤后马蹄内翻畸形患者的临床资料进行回顾性分析。该队列包括18例男性和11例女性，年龄在15至57岁之间（平均24.3岁）。所有患者均表现为踝关节强直并伴有马蹄内翻畸形。手术过程中，根据伊里扎洛夫穿针原则安装外固定架，并在踝关节处进行微创截骨术。同时，通过微创跟腱延长实现软组织松解。术后，通过逐步调整外固定架完成多平面畸形矫正。截骨部位骨愈合后拆除固定架，随后进行支具固定。记录手术时间、术中出血量、固定架佩戴时间及并发症。术后结果包括评估畸形矫正情况和截骨部位的骨愈合情况。使用美国矫形足踝协会（AOFAS）踝-后足评分和视觉模拟量表（VAS）评分的术前和术后评分评估功能改善和疼痛缓解情况。
29例患者均获随访12 - 24个月（平均18个月）。平均手术时间为85.6分钟，平均术中出血量为110毫升。通过逐步调整固定架，在26 - 80天内（平均40.7天）实现了完全畸形矫正。矫正完成时，所有踝关节均恢复至中立位或背屈5° - 10°，足功能正常。3例患者（10.3%）发生浅表针道感染，经局部伤口护理、加强护理及口服抗生素后治愈。未观察到深部或全身感染。1例患者在固定架佩戴期间因跌倒导致跟骨半针骨折，但未发生骨块移位。未报告血管或神经并发症。所有截骨部位均实现了完全骨愈合，无骨不连。末次随访时，AOFAS踝-后足评分从术前的42.7±8.7提高至术后的65.7±9.3，VAS评分从术前的4.5±1.3降至术后的2.5±1.1，差异有统计学意义（<0.05）。功能结果评定为优14例，良13例，可1例，差1例，优良率为93.1%。
伊里扎洛夫外固定技术联合足部有限截骨术的逐步矫正策略能有效矫正创伤后马蹄内翻畸形，同时保留软组织完整性。该方法并发症少且大多可控，实现了与传统开放手术相当的对线稳定性和融合效果，是治疗复杂足踝畸形的有效方法。
