分期Ilizarov技术肌腱转移矫正儿麻后遗重度足畸形

Staged Ilizarov technique and tendon transfer for correction of severe foot deformity secondary to poliomyelitis

摘要:

[目的]探讨分期 Ilizarov 技术肌腱转移治疗儿麻后遗症重度足下垂内翻畸形的临床疗效。[方法]回顾性分析 2012 年 6 月—2018 年 6 月本院一期行跟腱延长联合 Ilizarov 技术矫正足下垂内翻畸形、二期行胫后肌外移术维持软组织肌力平衡治疗的 24 例儿麻后遗症重度足下垂内翻畸形患者的临床资料。[结果]所有患者均顺利完成手术，术中未出现神经、血管损伤等严重并发症。所有患者随访时间平均(2.6±0.8)年。术后 8 个月和末次随访时，踝背伸-跖屈关节活动度较术前改善明显(P＜0.05)，AOFAS 踝-后足评分较术前显著增加(P＜0.05)。影像方面，与术前相比，术后 8 个月和末次随访时，踝关节退变分级 Morrey-Wiedeman 均较术前显著改善(P＜0.05)。[结论]分期 Ilizarov 技术肌腱转移矫正儿麻后遗症重度足下垂内翻畸形疗效确切。

Abstract:

[Objective] To investigate the clinical efficacy of staged Ilizarov technique and tendon transfer in the treatment of severe tali- pes equinovarus deformity secondary to poliomyelitis. [Methods] A retrospective study was conducted on 24 patients who received Achilles tendon lengthening combined with Ilizarov technique to correct the deformities in the first stage, followed by transfer of posterior tibialis to maintain muscle balance in the second stage for talipes equinovarus deformity secondary to poliomyelitis in our department from June 2012 to June 2018. [Results] All patients had two-stage surgical procedures and relative interoperative management performed successfully with no serious complications such as nerve and vascular injury during the preoperative period. As time went in the follow-up period lasted for (2.6±0.8) years on an average, the range of motion of ankle dorsi flexion and metatarsal flexion joint significantly improved (P＜0.05) ，the AOFAS ankle-hindfoot score significantly improved (P＜0.05) . In term of radiograph, Morrey-Wiedeman classification of ankle degenera- tion were significantly improved at 8 months after operation and at the last follow-up compared with those before operation (P＜0.05) . [Conclusion] The staged Ilizarov technique and tendon transfer are effective treatment for correction of severe talipes equinovarus deformity sec- ondary to poliomyelitis.