• 北京市垂楊柳醫(yī)院矯形外科（北京，100022）;

【摘 要】 目的 觀察應(yīng)用有限矯形手術(shù)與Ilizarov技術(shù)治療青少年先天性馬蹄內(nèi)翻足（congenital clubfoot，CCF）的臨床療效， 探討CCF外科矯正與功能重建新技術(shù)、新理念。 方法 2003年9月－2010年7月，收治25例40足青少年CCF。男14例20足，女11例20足；年齡12～25歲，平均15.7歲。左足4例，右足6例，雙足15例。根據(jù)秦氏馬蹄內(nèi)翻足畸形分度：Ⅰ度9足，Ⅱ度17足，Ⅲ度14足。合并小腿內(nèi)旋畸形9足，右側(cè)髖關(guān)節(jié)半脫位1例。采用有限軟組織松解與骨性截骨手術(shù)后，9足Ⅰ度畸形者安裝組合式外固定器， 31足殘留畸形安裝Ilizarov外固定牽伸器。術(shù)后5～7 d開(kāi)始矯正，以0.5～1.0 mm/d為宜；待踝關(guān)節(jié)矯正至過(guò)伸5～10°，足呈輕度外翻后停止?fàn)可?，矯正位攜帶外固定架并負(fù)重行走4～6周。雙足畸形患者分兩期進(jìn)行手術(shù)，手術(shù)間隔3～6個(gè)月，平均4個(gè)月。 結(jié)果 9足術(shù)后佩戴組合式外固定器6～12周，平均8周；31足佩戴Ilizarov外固定牽伸器6～17周，平均13周。患者均獲隨訪，隨訪時(shí)間8個(gè)月～6年，平均37個(gè)月。牽拉矯形期間6例6足發(fā)生針道輕度感染，均經(jīng)對(duì)癥處理后感染消失。術(shù)后2年1例1足畸形部分復(fù)發(fā)，經(jīng)再次安裝Ilizarov外固定牽伸器負(fù)重行走4周，矯正滿(mǎn)意；其余畸形足在隨訪期內(nèi)均獲得滿(mǎn)意矯正和全足底持重。末次隨訪時(shí)根據(jù)國(guó)際馬蹄足畸形研究會(huì)（ICFSG）的評(píng)分系統(tǒng)，獲優(yōu)28足，良10足，可2足，優(yōu)良率95%。 結(jié)論 有限矯形手術(shù)結(jié)合Ilizarov技術(shù)矯治青少年CCF，符合生物學(xué)原理和微創(chuàng)外科原則，安全、微創(chuàng)、療效確切。該馬蹄內(nèi)翻足手術(shù)矯形策略遵循骨科自然重建理念，尤其適用于傳統(tǒng)矯形骨科手術(shù)難以治療的Ⅲ度CCF。

引用本文： 秦泗河,郭保逢,任龍喜,鄭學(xué)建,焦紹鋒. 有限矯形手術(shù)與Ilizarov技術(shù)治療青少年先天性馬蹄內(nèi)翻足. 中國(guó)修復(fù)重建外科雜志, 2012, 26(1): 31-35. doi: 復(fù)制

1. deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
2. Orthopade, 2010, 39 (11): 1071-1086.
3. talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
4. Angle Orthod, 2004, 74(1): 3-15.
5. Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
6. of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
7. clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
8. Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
9. Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual.
10. Weimann-Stahlschmidt K, Krauspe R, Westhoff B. Congenital clubfoot.
11. Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
12. David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
13. 秦泗河, 陳建文, 鄭學(xué)建, 等. Ilizarov張力-應(yīng)力法則結(jié)合三關(guān)節(jié)有限截骨矯正成年人重度馬蹄內(nèi)翻足. 中華骨科雜志, 2004, 24(6): 338-341.
14. Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
15. Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
16. Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
17. Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
18. Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
19. Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
20. Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
21. Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
22. Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
23. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
24. 秦泗河, 夏和桃, 蔡剛, 等. Ilizarov技術(shù)矯正合并皮膚瘢痕攣縮的僵硬型足踝畸形. 中華創(chuàng)傷骨科雜志, 2007, 9(12): 1106-1110．.
25. 陳建文, 秦泗河, 焦紹鋒, 等. 關(guān)節(jié)牽伸器及Ilizarov技術(shù)矯治小腿肌攣縮致膝踝關(guān)節(jié)畸形. 中國(guó)組織工程研究與臨床康復(fù), 2008, 12(39): 7636-7640．.
  1. 1. deformity and patient reported outcome. Acta Orthop Suppl, 2010, 81(339): 1-25.
  2. 2. Orthopade, 2010, 39 (11): 1071-1086.
  3. 3. talipes equinovarus correction. Ir Med J, 2010, 103(6): 166-167.
  4. 4. Angle Orthod, 2004, 74(1): 3-15.
  5. 5. Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
  6. 6. of resistant clubfoot: is it an effective solution? J Pediatr Orthop, 2006, 26(4): 432-437.
  7. 7. clubfoot using a simple Ilizarov frame. Int Orthop, 2004, 28(3): 183-186．.
  8. 8. Colaço HB, Patel S, Lee MH, et al. Congenital clubfoot: a review. Br J Hosp Med (Lond), 2010, 71(4): 200-205.
  9. 9. Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual.
  10. 10. Weimann-Stahlschmidt K, Krauspe R, Westhoff B. Congenital clubfoot.
  11. 11. Haene RA, Stephens MM. Ignacio Poseti and the Ponseti Method of congenital.
  12. 12. David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the ponseti method. J Foot Ankle Surg, 2011, 5(4): 494-497.
  13. 13. 秦泗河, 陳建文, 鄭學(xué)建, 等. Ilizarov張力-應(yīng)力法則結(jié)合三關(guān)節(jié)有限截骨矯正成年人重度馬蹄內(nèi)翻足. 中華骨科雜志, 2004, 24(6): 338-341.
  14. 14. Prem H, Zenios M, Farrell R, et al. Soft tissue Ilizarov correction of congenital talipes equinovarus—5 to 10 years postsurgery. J Pediatr Orthop, 2007, 27(2): 220-224.
  15. 15. Ferreira RC, Costa MT, Frizzo GG, et al. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int, 2007, 28(5): 557-568．.
  16. 16. Frost HM. A 2003 update of bone physiology and Wolff ’s law for clinicians.
  17. 17. Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International.
  18. 18. Alvarez C, De Vera M, Varghese R. Review of current methods used in the treatment of clubfoot at initial presentation and at recurrence. J Surg Orthop Adv, 2008, 17(2): 107-114．.
  19. 19. Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin, 2010, 15(2): 287-296.
  20. 20. Clarke NM, Uglow MG, Valentine KM. Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus. J Foot Ankle Surg, 2011, 50(5): 529-534.
  21. 21. Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br), 2010, 92(2): 277-283.
  22. 22. Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment.
  23. 23. El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected.
  24. 24. 秦泗河, 夏和桃, 蔡剛, 等. Ilizarov技術(shù)矯正合并皮膚瘢痕攣縮的僵硬型足踝畸形. 中華創(chuàng)傷骨科雜志, 2007, 9(12): 1106-1110．.
  25. 25. 陳建文, 秦泗河, 焦紹鋒, 等. 關(guān)節(jié)牽伸器及Ilizarov技術(shù)矯治小腿肌攣縮致膝踝關(guān)節(jié)畸形. 中國(guó)組織工程研究與臨床康復(fù), 2008, 12(39): 7636-7640．.