41例痉挛性脑瘫马蹄内翻足的手术矫正△

Surgical correction of equinovarus feet in 41 cases of spastic cerebral palsy

摘要:

[目的]探讨有限软组织松解结合不同外固定治疗痉挛性脑瘫马蹄内翻足的疗效。[方法]2019 年 9 月—2020 年 12 月共 41 例 （58 足） 痉挛性脑瘫马蹄内翻足，分别采用有限软组织松解+石膏固定术或有限软组织松解/截骨矫形+组合式/环式外固定架固定治疗，总结围手术期及随访结果。[结果] 58 足中，跟腱延长、胫后肌腱延长 （84.5%）；足的截骨或关节融合 （74.1%）。患者均获至少 24 个月随访。全部病例拆除外固定架后及末次随访时踝背伸肌力、外翻肌力、肌张力较术前均显著改善 （P＜0.05），踝-后足 AOFAS 评分显著增加（P＜0.05），ICFSG 评分、ASHWORTH 评分显著减少（P＜0.05）。[结论]有限软组织松解结合外固定技术治疗痉挛性脑瘫马蹄内翻足畸形，可以取得比较满意且相对理想的效果。

Abstract:

[Objective] To investigate the clinical outcomes of limited soft tissue release combined with different external fixations in the treatment of equinovarus feet in spastic cerebral palsy. [Methods] From September 2019 to December 2020, a total of 41 patients (58 feet) who suffered from spastic cerebral palsy received limited soft tissue release combined with plaster fixation, or limited soft tissue release, osteotomy combined with external fixator fixation for equinovarus feet. The perioperative and follow-up consequences were summarized. [Results] Of 58 feet, Achilles tendon lengthened and tibial posterior tendon lengthened were done in 84.5%, while foot osteotomy or joint fusion in 74.1%. All patients were followed up for at least 24 months. After removal of the external fixator and at the last follow-up, all cases got sig- nificant improvement in terms of extensor strength, valgus strength, muscle tension and efficacy grade (P＜0.05). The AOFAS score of the an- kle and hindfoot was significantly increased (P＜0.05), whereas the ICFSG score and Ashworth score were significantly decreased postopera- tively (P＜0.05). [Conclusion] The limited soft tissue release combined with external fixation can achieve satisfactory results for treatment of clubfoot deformity secondary to spastic cerebral palsy.