截骨联合Ilizarov技术治疗失神经足畸形△（开放获取）

(Open Access) Osteotomy combined with Ilizarov technique for foot deformity secondary to denervation

摘要:

[目的] 探讨足部截骨联合Ilizarov 技术治疗失神经支配性足部僵硬性畸形合并溃疡的临床效果。[方法] 回顾性分析2019 年4 月—2022 年12 月手术治疗失神经支配性足部僵硬性畸形合并溃疡20 例（24 足） 患者的临床资料。所有患者均行足部肌腱延长、肌腱转位、三关节截骨后安装Ilizarov 架，术后5~7 d 调整外固定架逐步矫正足部残余畸形，足部溃疡术中清创后常规换药。2 例患者为Wanger IV 级溃疡同时行胫骨横向搬移术。评价临床及影像结果。[结果] 患者手术过程均顺利，外固定架调整时间平均（23.3±5.4） d，足部溃疡愈合时间平均（22.6±5.2） d，佩戴外固定架时间平均（99.3±14.4） d。随访时间平均（2.3±0.9） 年。与术前相比，术后3 个月及末次随访时VAS 评分显著减小[(3.2±0.4), (0.4±0.2), (0.3±0.2), P＜0.001]，AOFAS 评分显著增加[(37.8±3.9), (78.4±4.0), (88.3±4.0), P＜0.001]。影像方面，随时间推移，胫骨跟骨角（tibial-calcaneal angle, TCA）[(123.2±8.4)°, (63.7±1.6)°, (63.6±1.6)°, P＜0.001]、Meary 角[(38.3±6.0)°, (3.6±1.0)°, (3.5±0.7)°, P＜0.001] 显著减小，术后3 个月，所有截骨均完全融合。[结论] 足部截骨联合Ilizarov 技术治疗失神经支配性足部僵硬性畸形合并溃疡，安全、可靠，短期随访效果满意。

Abstract:

[Objective] To investigate the clinical outcomes of foot osteotomy combined with Ilizarov technique in the treatment of de-nervated foot stiffness deformity complicated with ulcer. [Methods] A retrospective study was conducted on 20 patients (24 feet) who re-ceived surgical correction for denervated foot stiffness deformity complicated with ulcer in our hospitals from April 2019 to December 2022.All the patients underwent Achilles's tendon lengthening, tendon transfer and triple hindfoot osteotomy, followed by Ilizarov frame installed.The external frame was adjusted to gradually correct the residual deformity of the foot 5~7 days after operation, with dressing changed regu-larly after debridement of the foot ulcer. Two patients with Wanger grade IV ulcer received lateral tibial distraction simultaneously. Clinicaland imaging results were evaluated. [Results] All patients had operation performed smoothly, with the average external fixator adjustmenttime of (23.3±5.4) days, the average healing time of foot ulcer of (22.6±5.2) days, and the average wearing time of external fixator of (99.3±14.4) days. All the patients were followed up for a mean of (2.3±0.9) years. With time preoperatively, 3 months postoperatively and at the lastfollow-up, the VAS score significantly reduced [(3.2±0.4), (0.4±0.2), (0.3±0.2), P＜0.001], while the AOFAS score significantly increased[(37.8±3.9), (78.4±4.0), (88.3±4.0), P＜0.001]. Regarding imaging, the tibiocalcaneal angle (TCA) [(123.2±8.4)°, (63.7±1.6)°, (63.6±1.6)°, P＜0.001], Meary angle [(38.3±6.0)°, (3.6±1.0)°, (3.5±0.7)°, P＜0.001] were significantly reduced over time points abovementioned, and all pa-tients got osteotomy healed 3 months after surgery. [Conclusion] Triple hindfoot osteotomy combined with Ilizarov technique is safe, reliablemethod and achieves satisfactory short-term consequence for treatment of denervated foot stiffness deformity complicated with ulcer.