Zhang Dongfeng, Yang Siyu, Shi Bingke, Li Shuliang, Zhen Lei, Wang Yushun, Zhang Yingqi, Qin Sihe, Pan Qi
Department of Orthopaedic and Reconstructive Surgery, South China Hospital of Shenzhen University, Shenzhen Guangdong, 518116, P. R. China.
Department of Orthopedic Surgery, Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Aug 15;39(8):989-993. doi: 10.7507/1002-1892.202505077.
To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation.
A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy.
The deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%.
Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
总结Ilizarov法矫正马蹄内翻足畸形时踝关节铰链位置的设计方法，探讨其在预防踝关节脱位中的应用价值。
回顾性研究2021年9月至2024年12月收治的符合入选标准的28例僵硬性马蹄内翻足畸形患者（34足）。男19例，女9例，平均年龄31.8岁（19 - 47岁）。按Dimeglio分型，Ⅲ度21足，Ⅳ度13足。病因：创伤后遗症9例，先天性足部畸形15例，脊柱裂后遗症1例，周围神经病1例，脑瘫后遗症2例。畸形持续时间6～46年，平均29.3年。所有患者均采用Ilizarov环形外固定器治疗，术前根据足踝标准侧位X线片及Ilizarov肢体畸形矫正中心旋转成角（CORA）原则规划踝关节铰链位置。采用2008年国际马蹄内翻足研究组（ICFSG）评分系统评估疗效。
所有患者僵硬性马蹄内翻足畸形均完全矫正，患者可跖屈负重行走，与术前相比踝关节负重行走明显改善。矫正过程中未出现踝关节脱位、距骨撞击或挤压、局部皮肤坏死、针道感染、肢体麻木等并发症。所有患者随访5～39个月，平均18.1个月。末次随访时，根据ICFSG评分系统，优23足，良10足，可1足，优良率为97%。
依据CORA原则设计踝关节铰链位置，可有效避免马蹄内翻足畸形矫正过程中踝关节脱位、距骨撞击、胫距关节挤压等踝关节不良事件，在临床实践中有良好的应用价值。
