Liu Lizhu, Qin Sihe, Shi Lei
Department of Orthopedic Surgery, Rehabilitation Hospital of the 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):1002-1007. doi: 10.7507/1002-1892.202505016.
To investigate the effectiveness of applying a standardized rehabilitation process in correction of adult clubfoot with the Ilizarov technique.
Thirty-eight adult patients who underwent orthopedic treatment with Ilizarov technique for clubfoot between August 2022 and December 2024 were retrospectively analyzed. The patients were divided into a study group and a control group with 19 cases in each group according to the different rehabilitation management processes and methods. The differences in baseline data such as gender, age, side, and preoperative Holden walking function grading between the two groups were not significant ( 0.05). In both groups, most of the clubfoot deformities were surgically corrected first, and the residual deformities were corrected by dynamic slow retraction with Ilizarov ring-type external fixation frame. The study group adopted standardized rehabilitation process management mode, including preoperative lower limb muscle strength training, postoperative pain and swelling management, weight-bearing management, gait and lower limb stability training. The control group adopted the conventional postoperative rehabilitation management mode. The occurrence of complications was recorded, including pin tract infection, ankle stiffness and pain, and deformity recurrence. Holden walking function grading was used to evaluate the walking ability of the patients. Clinical efficacy was evaluated by the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale. Patient satisfaction was evaluated by Likert score.
Patients in both groups successfully completed surgery and rehabilitation and were followed up. The follow-up time ranged from 8 to 29 months, with a mean of 18.5 months. Among them, the follow-up time was (18.8±5.5) months in the study group and (18.2±5.7) months in the control group, and the difference between groups was not significant ( =0.316, =0.754). The postoperative incidences of pin tract infection, ankle stiffness and pain, and deformity recurrence in the study group were 10.53%, 5.26%, and 5.26%, respectively, and in the control group were 21.05%, 36.84%, and 15.79%, respectively. And the difference between groups in the incidence of ankle stiffness and pain was significant ( =0.042). At last follow-up, both groups showed an improvement in Holden walking function grading compared to preoperative levels ( <0.05), and the grading of the study group was significantly higher than that of the control group ( =0.006). According to the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale, the grade difference between groups was not significant ( =0.089), and the excellent and good rates of clinical efficacy in study group and control group were 89.47% (17/19) and 73.68% (14/19), respectively. Patient satisfaction in study group was significantly better than that in control group ( =0.036).
Standardized rehabilitation process can effectively promote the postoperative functional recovery of adult clubfoot treated with Ilizarov technique, reduce the risk of complications and improve effectiveness.
探讨应用标准化康复流程对成人马蹄内翻足采用伊里扎洛夫技术进行矫正的效果。
回顾性分析2022年8月至2024年12月期间采用伊里扎洛夫技术对马蹄内翻足进行矫形治疗的38例成年患者。根据康复管理流程和方法的不同将患者分为研究组和对照组，每组19例。两组患者的性别、年龄、患侧、术前霍尔登步行功能分级等基线资料差异无统计学意义（P>0.05）。两组中，多数马蹄内翻足畸形先进行手术矫正，残余畸形采用伊里扎洛夫环形外固定架动态缓慢牵拉矫正。研究组采用标准化康复流程管理模式，包括术前下肢肌力训练、术后疼痛与肿胀管理、负重管理、步态及下肢稳定性训练。对照组采用传统术后康复管理模式。记录并发症的发生情况，包括针道感染、踝关节僵硬及疼痛、畸形复发。采用霍尔登步行功能分级评估患者的步行能力。采用秦泗河畸形矫正伤残修复与功能重建术后疗效评定量表评估临床疗效。采用Likert评分评估患者满意度。
两组患者均成功完成手术及康复并进行随访。随访时间为8至29个月，平均18.5个月。其中，研究组随访时间为（18.8±5.5）个月，对照组为（18.2±5.7）个月，组间差异无统计学意义（t=0.316，P=0.754）。研究组术后针道感染、踝关节僵硬及疼痛、畸形复发的发生率分别为10.53%、5.26%、5.26%，对照组分别为21.05%、36.84%、15.79%。两组踝关节僵硬及疼痛发生率差异有统计学意义（P=0.042）。末次随访时，两组霍尔登步行功能分级均较术前有所改善（P<0.05），且研究组分级显著高于对照组（P=0.006）。根据秦泗河畸形矫正伤残修复与功能重建术后疗效评定量表，组间分级差异无统计学意义（P=0.089），研究组和对照组临床疗效优良率分别为89.47%（17/19）和73.68%（14/19）。研究组患者满意度显著优于对照组（P=0.036）。
标准化康复流程可有效促进采用伊里扎洛夫技术治疗的成人马蹄内翻足术后功能恢复，降低并发症风险，提高治疗效果。
