Ilizarov技术矫正成人马蹄内翻足是否踝关节镜清理△（开放获取）

Ilizarov technique correcting adult talipes equinovarus with or without ankle arthroscopic debridement

摘要:

[目的] 探讨关节镜辅助 Ilizarov 技术矫正成人马蹄内翻足的临床疗效。[方法] 选取 2019 年 5 月—2023 年 5 月 37 例（44 足）成人马蹄内翻足患者纳入本研究，采用随机数字表法分为两组。其中，23 足采用踝关节镜下清理联合 Ilizarov 技术矫正（清理组），另外 21 足仅采用传统 Ilizarov 技术矫形，未行踝关节镜下清理（未清理组）。比较两组治疗期、随访及影像指标。[结果]清理组手术时间显著长于未清理组 [(121.6±28.5) min vs (92.3±18.4) min, P＜0.001]，但是，前者外固定架带架时间显著短于后者 [(71.3±10.5) d vs (82.5±11.9) d, P=0.012] 。两组术中失血量、切口愈合等级、下地行走时间、住院时间、外固定调整次数及总体并发症发生率的差异均无统计学意义 （P＞0.05）。随访时间平均 （6.3±3.2） 个月。与术前相比，末次随访时，两组患者 VAS、ICFSG、AOFAS 评分及踝跖屈-背伸、足内-外翻 ROM 均显著改善（P＜0.05）。术前两组间上述指标的差异均无统计学意义 （P＞0.05），末次随访时，清理组 VAS 评分 [(1.8±1.2) vs (3.8±1.4) , P＜0.001]、AOFAS 评分 [(85.7±10.7) vs (74.8±11.4) , P=0.005]、踝跖屈-背伸 ROM [(42.8±11.4)° vs (33.6±7.8)°, P=0.005] 均显著优于未清理组。末次随访时，清理组临床优良率显著高于未清理组 (91.3% vs 66.7% , P=0.043） 。影像方面，末次随访时，清理组 Takakura 关节退变分级显著优于未清理组 [I/II/III/IV, (16/7/0/0) vs (7/10/4/0), P=0.025]。但两组间侧位距跟角（lateral talocalcaneal angle, LTCA）、距跟角 （talocalcaneal angle, TCA）、距第一跖骨角 （talo-first metatarsal angle, TFMA）的差异无统计学意义（P＞0.05）。[结论] 关节镜清理辅助 Ilizarov 技术矫正成人马蹄内翻足可以减少外固定架使用时间，提高治疗效果，改善功能。

Abstract:

[Objective] To explore the clinical efficacy of ankle arthroscopic debridement combined with Ilizarov technique in correcting adult talipes equinovarus. [Methods] A total of 37 adult patients (44 feet) with clubfoot from May 2019 to May 2023 were included in this study, and were divided into two groups by the random number table method. Of them, 23 feet received Ilizarov technique combined with ankle arthroscopic debridement (the debridement group), while the other 21 feet underwent traditional Ilizarov technique only without ankle arthroscopic debridement (the non-debridement group). The documents regarding to treatment period, follow-up and images were compared between the two groups. [Results] Although the debridement group consumed significantly longer operation time than the non-debridement group [(121.6±28.5) min vs (92.3±18.4) min, P＜0.001], the former had significantly shorter external fixator bearing time than the latter [(71.3±10.5) days vs (82.5±11.9) days, P=0.012]. There were no statistically significant differences in intraoperative blood loss, incision healing grade, walking time, hospital stay, the number of external fixation adjustments, and the overall incidence of complications between the two groups (P＞0.05). The patients in both groups were followed up for (6.3±3.2) months in a mean. The VAS, ICFSG and AOFAS scores, as well as ankle plantarflexion-dorsiflexion range of motion (ROM) and inversion-eversion ROM were significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05). There was no statistically significant difference in the abovesaid items between the two groups before the operation (P＞0.05), however, the debridement group proved significantly superior to the non-debridement group at the last follow-up in terms of VAS score [(1.8±1.2) vs (3.8±1.4) , P＜0.001], AOFAS score [(85.7±10.7) vs (74.8±11.4) , P=0.005] and ankle plantarflexion-dorsiflexion ROM [(42.8±11.4)° vs (33.6±7.8)°, P=0.005]. Moreover, the debridement group was also significantly better than the non-debridement group in the clinical excellent and good rate at the last follow-up (91.3% vs 66.7%, P=0.043). As for imaging, the debridement group was significantly better over the non-debridement group in Takakura's degeneration grade at the last follow-up [I/ II/III/IV, (16/7/0/0) vs (7/10/4/0), P=0.025], despite the fact that no statistically significant differences were noted between the two groups regarding the lateral talocalcaneal angle (LTCA), talocalcaneal angle (TCA), and talo-first metatarsal angle (TFMA) (P＞0.05). [Conclusion] The ankle arthroscopic debridement does enhance clinical consequece of Ilizarov technique correcting adult talipes equinovarus, with advantages of reducing external fixator bearing time and improving functional recovery.