發(fā)布時(shí)間：2018-03-25 21:15

  本文選題：Ilizarov外固定器　切入點(diǎn)：足部畸形　出處：《中國(guó)矯形外科雜志》2017年01期

【摘要】：[目的]觀察外固定器治療腦性癱瘓僵硬性足部畸形的臨床效果,探討腦性癱瘓足部畸形外科矯正和功能重建的新技術(shù)。[方法]回顧性分析1988年10月~2013年3月165例腦性癱瘓僵硬性足部畸形患者,236足,根據(jù)足部畸形的特征,設(shè)計(jì)不同構(gòu)型的外固定器。上運(yùn)動(dòng)神經(jīng)元損傷型足部畸形主要實(shí)施選擇性脊神經(jīng)后根切斷術(shù)、選擇性脛神經(jīng)縮窄手術(shù)和距下關(guān)節(jié)外融合手術(shù)或距下關(guān)節(jié)融合術(shù),同時(shí)安裝外固定器。下運(yùn)動(dòng)神經(jīng)元損傷型足部畸形主要實(shí)施軟組織松解、肌腱轉(zhuǎn)位術(shù)或截骨手術(shù),同時(shí)安裝外固定器。[結(jié)果]154例216足獲得至少3年以上隨訪,馬蹄內(nèi)翻足64足,馬蹄足70足,馬蹄外翻足82足。其中上運(yùn)動(dòng)神經(jīng)元損傷型足部畸形62足,下運(yùn)動(dòng)神經(jīng)元損傷型足部畸形154足。佩戴外固定器時(shí)間8~13周,平均10周。采用Laaveg-Ponseti足功能評(píng)分系統(tǒng):優(yōu)88足,良78足,可34足,差16足,優(yōu)良率76.9%。第一次術(shù)后復(fù)發(fā)14足,復(fù)發(fā)率6.5%。釘?shù)栏腥?2足,清理炎性分泌物或更換釘?shù)牢恢煤笾斡�。足跟部皮膚壞死、足底部軟組織壞死和跟骨慢性骨髓炎1例,徹底清創(chuàng)和腓腸神經(jīng)營(yíng)養(yǎng)血管皮瓣轉(zhuǎn)移后治愈。踝關(guān)節(jié)骨性關(guān)節(jié)炎1例,踝關(guān)節(jié)融合后治愈。[結(jié)論]外固定器治療腦性癱瘓僵硬性足部畸形符合生物學(xué)重建理論,可提高療效,減少并發(fā)癥。
[Abstract]:[objective] to observe the clinical effect of external fixator in the treatment of inflexible foot deformity of cerebral palsy. To discuss the new technique of surgical correction and functional reconstruction of cerebral palsy foot malformation. [methods] 165 patients with rigid foot malformation of cerebral palsy from October 1988 to March 2013 were analyzed retrospectively. Different types of external fixators were designed. Selective posterior rhizotomy, selective tibial nerve constriction, subtalar extraarticular fusion or subtalar arthrodesis were performed for upper motor neuron injury foot deformity. The soft tissue release, tendon transposition or osteotomy were performed at the same time. [results] 154 cases 216 feet were followed up for at least 3 years, and 64 feet with equinovarus varus equinovarus were followed up at least 3 years. 70 feet of horseshoe, 82 feet of equinovarus valgus, 62 feet of upper motor neuron injury foot deformity, 154 feet of inferior motor neuron injury foot malformation. The time of wearing external fixator was 813 weeks. Average 10 weeks. Laaveg-Ponseti foot function scoring system was used: excellent 88 feet, good 78 feet, fair 34 feet, poor 16 feet, excellent and good rate 76.9.The recurrence rate was 6.5% and recurrence rate was 6.5%. 1 case with skin necrosis of heel, soft tissue necrosis of the base of foot and chronic osteomyelitis of calcaneus, 1 case cured after thorough debridement and sural neurovascular flap transfer, 1 case of ankle osteoarthritis, 1 case of ankle osteoarthritis, 1 case of ankle osteoarthritis, 1 case of complete debridement and sural neurovascular flap transfer. [conclusion] the treatment of inflexible foot deformity of cerebral palsy with external fixator accords with the theory of biological reconstruction, which can improve the curative effect and reduce complications.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院骨科;國(guó)家康復(fù)輔具研究中心附屬康復(fù)醫(yī)院骨科;
【基金】：國(guó)家十二五科技支撐計(jì)劃基金資助項(xiàng)目(編號(hào):2012BAI33B06)
【分類(lèi)號(hào)】：R658.3

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