Paley D
Maryland Center for Limb Lengthening and Reconstruction, James Lawrence Kernan Hospital, Inc., Baltimore, Maryland 21207.
Clin Orthop Relat Res. 1993 Aug(293):97-111.
Twenty-five very complex foot deformities were treated by Ilizarov distraction osteotomies. The osteotomy types included supramalleolar, U, V, posterior calcaneal, talocalcaneal neck, midfoot, and metatarsal osteotomies. In addition, the leg was lengthened and widened in most cases. The mean treatment time was 6.4 months. There were 20 minor or major complications related to the foot osteotomies in 18 feet, including deep pin-tract infection in three, failure of osteotomy separation in nine, acute postoperative tarsal tunnel syndrome in two, toe contractures in three, wire breakage or cutout in two, and buckle fracture in one. Nineteen secondary procedures were required in 13 patients to treat these complications. The final result was a plantigrade foot in 22 in late follow-up evaluation. The three nonplantigrade feet were attributable to unrecognized heel varus in one, ball and socket ankle joint in one, and partial growth arrest progressive deformity in one. Gait was improved in all cases. Pain was eliminated in all but two patients. Based on these criteria, the results were judged to be satisfactory in 22 and unsatisfactory in three. The Ilizarov method can successfully correct complex foot deformities despite complications.
25例非常复杂的足部畸形采用Ilizarov牵张截骨术进行治疗。截骨类型包括踝关节上截骨、U形截骨、V形截骨、跟骨后部截骨、距跟颈截骨、中足截骨和跖骨截骨。此外，多数病例中还进行了小腿延长和增宽。平均治疗时间为6.4个月。18只足的足部截骨出现20例轻或重度并发症，包括3例深部针道感染、9例截骨分离失败、2例急性术后跗管综合征、3例趾挛缩、2例钢丝断裂或穿出以及1例扣锁骨折。13例患者需要进行19次二次手术来治疗这些并发症。在后期随访评估中，22例最终结果为足跖行。3例非跖行足分别归因于1例未识别的足跟内翻、1例球窝踝关节和1例部分生长停滞渐进性畸形。所有病例的步态均有改善。除2例患者外，其余患者疼痛均消失。基于这些标准，22例结果判定为满意，3例不满意。尽管有并发症，但Ilizarov方法能够成功矫正复杂的足部畸形。
