有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足_《中國修復重建外科雜志》

作者：

秦泗河 , 郭保逢 , 任龍喜 , 鄭學建 , 焦紹鋒

北京市垂楊柳醫院矯形外科（北京，100022）;

關鍵詞：

先天性馬蹄內翻足 Ilizarov技術有限矯形手術青少年

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【摘要】目的觀察應用有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足（congenital clubfoot，CCF）的臨床療效，探討CCF外科矯正與功能重建新技術、新理念。方法 2003年9月－2010年7月，收治25例40足青少年CCF。男14例20足，女11例20足；年齡12～25歲，平均15.7歲。左足4例，右足6例，雙足15例。根據秦氏馬蹄內翻足畸形分度：Ⅰ度9足，Ⅱ度17足，Ⅲ度14足。合并小腿內旋畸形9足，右側髖關節半脫位1例。采用有限軟組織松解與骨性截骨手術后，9足Ⅰ度畸形者安裝組合式外固定器， 31足殘留畸形安裝Ilizarov外固定牽伸器。術后5～7 d開始矯正，以0.5～1.0 mm/d為宜；待踝關節矯正至過伸5～10°，足呈輕度外翻后停止牽伸，矯正位攜帶外固定架并負重行走4～6周。雙足畸形患者分兩期進行手術，手術間隔3～6個月，平均4個月。結果 9足術后佩戴組合式外固定器6～12周，平均8周；31足佩戴Ilizarov外固定牽伸器6～17周，平均13周。患者均獲隨訪，隨訪時間8個月～6年，平均37個月。牽拉矯形期間6例6足發生針道輕度感染，均經對癥處理后感染消失。術后2年1例1足畸形部分復發，經再次安裝Ilizarov外固定牽伸器負重行走4周，矯正滿意；其余畸形足在隨訪期內均獲得滿意矯正和全足底持重。末次隨訪時根據國際馬蹄足畸形研究會（ICFSG）的評分系統，獲優28足，良10足，可2足，優良率95%。結論有限矯形手術結合Ilizarov技術矯治青少年CCF，符合生物學原理和微創外科原則，安全、微創、療效確切。該馬蹄內翻足手術矯形策略遵循骨科自然重建理念，尤其適用于傳統矯形骨科手術難以治療的Ⅲ度CCF。

引用本文： 秦泗河,郭保逢,任龍喜,鄭學建,焦紹鋒. 有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足. 中國修復重建外科雜志, 2012, 26(1): 31-35. doi: 復制

1.	deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
2.	Orthopade, 2010, 39 (11): 1071-1086.
3.	talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
4.	Angle Orthod, 2004, 74(1): 3-15.
5.	Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
6.	of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
7.	clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
8.	Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
9.	Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual.
10.	Weimann-Stahlschmidt K, Krauspe R, Westhoff B. Congenital clubfoot.
11.	Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
12.	David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
13.	秦泗河, 陳建文, 鄭學建, 等. Ilizarov張力-應力法則結合三關節有限截骨矯正成年人重度馬蹄內翻足. 中華骨科雜志, 2004, 24(6): 338-341.
14.	Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
15.	Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
16.	Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
17.	Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
18.	Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
19.	Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
20.	Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
21.	Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
22.	Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
23.	El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
24.	秦泗河, 夏和桃, 蔡剛, 等. Ilizarov技術矯正合并皮膚瘢痕攣縮的僵硬型足踝畸形. 中華創傷骨科雜志, 2007, 9(12): 1106-1110．.
25.	陳建文, 秦泗河, 焦紹鋒, 等. 關節牽伸器及Ilizarov技術矯治小腿肌攣縮致膝踝關節畸形. 中國組織工程研究與臨床康復, 2008, 12(39): 7636-7640．.

1. deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
2. Orthopade, 2010, 39 (11): 1071-1086.
3. talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
4. Angle Orthod, 2004, 74(1): 3-15.
5. Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
6. of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
7. clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
8. Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
9. Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual.
10. Weimann-Stahlschmidt K, Krauspe R, Westhoff B. Congenital clubfoot.
11. Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
12. David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
13. 秦泗河, 陳建文, 鄭學建, 等. Ilizarov張力-應力法則結合三關節有限截骨矯正成年人重度馬蹄內翻足. 中華骨科雜志, 2004, 24(6): 338-341.
14. Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
15. Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
16. Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
17. Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
18. Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
19. Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
20. Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
21. Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
22. Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
23. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
24. 秦泗河, 夏和桃, 蔡剛, 等. Ilizarov技術矯正合并皮膚瘢痕攣縮的僵硬型足踝畸形. 中華創傷骨科雜志, 2007, 9(12): 1106-1110．.
25. 陳建文, 秦泗河, 焦紹鋒, 等. 關節牽伸器及Ilizarov技術矯治小腿肌攣縮致膝踝關節畸形. 中國組織工程研究與臨床康復, 2008, 12(39): 7636-7640．.

《中國修復重建外科雜志》

有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足

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《中國修復重建外科雜志》

有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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