儿童僵硬型马蹄内翻足的治疗策略
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摘要
目的探讨儿童僵硬型马蹄内翻足的治疗策略,评估其临床疗效。方法回顾性分析2013年7月至2016年9月广州新海医院治疗的47例(84足)僵硬型马蹄内翻足患儿的临床资料,对足畸形类型、发生机制和僵硬程度进行综合判断,结合患儿年龄采用针对性的矫形手术(Ponseti系列石膏固定和/或跖筋膜松解、跟腱和关节周围软组织松解、Ilizarov外固定等),按照国际马蹄内翻足研究会(ICFSG)评定标准评估手术效果。结果平均随访时间18个月(6～36个月)。根据ICFSG评定标准,优26例48足、良15例28足、可6例8足,总优良率90%(76/84)。无一例发生皮肤坏死、神经血管损伤并发症。结论在综合诊断僵硬型马蹄内翻足的基础上采取有针对性的矫形治疗策略,并发症少,矫形效果满意。
Objective To explore the treatment strategy for rigid congenital clubfoot in children,and to evaluate its clinical effects.Methods Clinical data of 47 patients(84 feet) with rigid congenital clubfoot treated from July 2013 to September 2016 in Guangzhou Xinhai Hospital were analyzed retrospectively.Based on the comprehensive diagnosis of foot deformity types,pathogenesis mechanisms and rigid degrees,and combined with the age of children,a targeted correction technique was carried out by Ponseti series plaster fixation and/or plantar fascia release,release of Achilles tendon and soft tissue surrounding the joint,and Ilizarov external fixation.The clinical effects were evaluated by International Clubfoot Study Group(ICFSG) scoring criteria.Results Patients were followed up with an average time of 18 months(6 to 36 months).According to ICFSG scores,26 cases(48 feet) were excellent,15 cases(28 feet) were good,6 cases(8 feet) were fair,with the excellent and good rate of 90%(76/84).No complications of skin necrosis,nervous or vascular injuries were found in this study.Conclusion A targeted correction strategy based on the comprehensive diagnosis of rigid congenital clubfoot in children could obtain satisfactory correction effects with less complications.
Objective To explore the treatment strategy for rigid congenital clubfoot in children,and to evaluate its clinical effects.Methods Clinical data of 47 patients(84 feet) with rigid congenital clubfoot treated from July 2013 to September 2016 in Guangzhou Xinhai Hospital were analyzed retrospectively.Based on the comprehensive diagnosis of foot deformity types,pathogenesis mechanisms and rigid degrees,and combined with the age of children,a targeted correction technique was carried out by Ponseti series plaster fixation and/or plantar fascia release,release of Achilles tendon and soft tissue surrounding the joint,and Ilizarov external fixation.The clinical effects were evaluated by International Clubfoot Study Group(ICFSG) scoring criteria.Results Patients were followed up with an average time of 18 months(6 to 36 months).According to ICFSG scores,26 cases(48 feet) were excellent,15 cases(28 feet) were good,6 cases(8 feet) were fair,with the excellent and good rate of 90%(76/84).No complications of skin necrosis,nervous or vascular injuries were found in this study.Conclusion A targeted correction strategy based on the comprehensive diagnosis of rigid congenital clubfoot in children could obtain satisfactory correction effects with less complications.
引文
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[2]Cartlidge IJ.Club foot in the Polynesian:an epidemiological survey[J].N Z Med J,1983,96(735):515-517.
[3]王延宙,王恒冰,张敏刚,等.Ponseti方法在不同年龄先天性马蹄内翻足中的应用[J].中华小儿外科杂志,2008,29(9):557-560.
[4]Diméglio A,Bensahel H,Souchet P,et al.Classification of clubfoot[J].J Pediatr Orthop B,1995,4(2):129-136.
[5]Celebi L,Muratli HH,Aksahin E.et al.Bensahel et al.and International Clubfoot Study Group evaluation of treated clubfoot:assessment of interobserver and intraobserver reliability[J].J Pediatr Orthop B,2006,15(1):34-36.
[6]Prichasuk S,Mulpruek P.Problems in surgical treatment of congenital clubfoot[J].J Med Assoc Thai,1992,75(Suppl 1):106-111.
[7]Riganti S,Coppa V,Nasto LA,et al.Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients[J].Foot Ankle Surg,2018,S1268-7731(18)30276-5.
[8]Bensahel H,Kuo K,Duhaime M,et al.Outcome evaluation of the treatment of clubfoot:the international language of clubfoot[J].J Pediatr Orthop B,2003,12(4):269-271.
[9]Harvey AR,Uglow MG,Clarke NM.Clinical and functional outcome of relapse surgery in severe congenital talipes equinovarus[J].J Pediatr Orthop[J].2003,12(1):49-55.
[10]Dragoni M,Farsetti P,Vena G,et al.Ponseti treatment of rigid residual deformity in congenital clubfoot after walking age[J].J Bone Joint Surg Am,2016,98(20):1706-1712.
[11]刘行,李明,刘星,等.Ilizarov技术治疗大龄儿童僵硬型先天性马蹄内翻足[J].中国修复重建外科杂志,2018,32(10):1267-1270.
[12]陈建文,秦泗河,焦绍锋,等.Ilizarov技术矫治儿童马蹄内翻足畸形[J].中华小儿外科科杂志,2010,31(5):350-353.
[13]李华龙,孔圳,孙永建.Ilizarov技术微创治疗儿童僵硬型马蹄内翻足[J].实用骨科杂志,2014,20(7):610-614.
[14]常峰,陈斌,荆志振,等.Ilizarov技术矫治复杂僵硬性马蹄内翻足[J].中华骨科杂志,2012,32(3):222-228.
[15]郭占豪,孙克明,王军建,等.Ilizarov外固定架联合有限矫形手术治疗青少年Ⅲ度马蹄内翻足畸形的临床疗效[J].中国临床医学,2017,24(5):719-722.
[16]胡新永,王义生,陈建文,等.外固定器治疗脑性瘫痪僵硬性足部畸形216足疗效分析[J].中国矫形外科杂志,2017,25(1):25-28.
[17]Shalaby H,Hefny H.Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique[J].Strategies Trauma Limb Reconstr,2007,2(1):21-30.
[18]Makhdoom A,Qureshi PA,Jokhio MF,et al.Resistant clubfoot deformities managed by Ilizarov distraction histogenesis[J].Indian J Orthop,2012,46(3):326-332.
[19]Gupta P,Bither N.Ilizarov in relapsed clubfoot:a necessary evil?[J].J Pediatr Orthop B,2013,22(6):589-594.21
[20]Faldini C,Traina F,Nanni M,et al.Congenital idiopathic talipes equinovarus before and after walking age:observations and strategy of treatment from a series of 88cases[J].J Orthop Traumatol,2016,17(1):81-87.
[2]Cartlidge IJ.Club foot in the Polynesian:an epidemiological survey[J].N Z Med J,1983,96(735):515-517.
[3]王延宙,王恒冰,张敏刚,等.Ponseti方法在不同年龄先天性马蹄内翻足中的应用[J].中华小儿外科杂志,2008,29(9):557-560.
[4]Diméglio A,Bensahel H,Souchet P,et al.Classification of clubfoot[J].J Pediatr Orthop B,1995,4(2):129-136.
[5]Celebi L,Muratli HH,Aksahin E.et al.Bensahel et al.and International Clubfoot Study Group evaluation of treated clubfoot:assessment of interobserver and intraobserver reliability[J].J Pediatr Orthop B,2006,15(1):34-36.
[6]Prichasuk S,Mulpruek P.Problems in surgical treatment of congenital clubfoot[J].J Med Assoc Thai,1992,75(Suppl 1):106-111.
[7]Riganti S,Coppa V,Nasto LA,et al.Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients[J].Foot Ankle Surg,2018,S1268-7731(18)30276-5.
[8]Bensahel H,Kuo K,Duhaime M,et al.Outcome evaluation of the treatment of clubfoot:the international language of clubfoot[J].J Pediatr Orthop B,2003,12(4):269-271.
[9]Harvey AR,Uglow MG,Clarke NM.Clinical and functional outcome of relapse surgery in severe congenital talipes equinovarus[J].J Pediatr Orthop[J].2003,12(1):49-55.
[10]Dragoni M,Farsetti P,Vena G,et al.Ponseti treatment of rigid residual deformity in congenital clubfoot after walking age[J].J Bone Joint Surg Am,2016,98(20):1706-1712.
[11]刘行,李明,刘星,等.Ilizarov技术治疗大龄儿童僵硬型先天性马蹄内翻足[J].中国修复重建外科杂志,2018,32(10):1267-1270.
[12]陈建文,秦泗河,焦绍锋,等.Ilizarov技术矫治儿童马蹄内翻足畸形[J].中华小儿外科科杂志,2010,31(5):350-353.
[13]李华龙,孔圳,孙永建.Ilizarov技术微创治疗儿童僵硬型马蹄内翻足[J].实用骨科杂志,2014,20(7):610-614.
[14]常峰,陈斌,荆志振,等.Ilizarov技术矫治复杂僵硬性马蹄内翻足[J].中华骨科杂志,2012,32(3):222-228.
[15]郭占豪,孙克明,王军建,等.Ilizarov外固定架联合有限矫形手术治疗青少年Ⅲ度马蹄内翻足畸形的临床疗效[J].中国临床医学,2017,24(5):719-722.
[16]胡新永,王义生,陈建文,等.外固定器治疗脑性瘫痪僵硬性足部畸形216足疗效分析[J].中国矫形外科杂志,2017,25(1):25-28.
[17]Shalaby H,Hefny H.Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique[J].Strategies Trauma Limb Reconstr,2007,2(1):21-30.
[18]Makhdoom A,Qureshi PA,Jokhio MF,et al.Resistant clubfoot deformities managed by Ilizarov distraction histogenesis[J].Indian J Orthop,2012,46(3):326-332.
[19]Gupta P,Bither N.Ilizarov in relapsed clubfoot:a necessary evil?[J].J Pediatr Orthop B,2013,22(6):589-594.21
[20]Faldini C,Traina F,Nanni M,et al.Congenital idiopathic talipes equinovarus before and after walking age:observations and strategy of treatment from a series of 88cases[J].J Orthop Traumatol,2016,17(1):81-87.