【摘 要】 目的 觀察應用有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足（congenital clubfoot，CCF）的臨床療效， 探討CCF外科矯正與功能重建新技術、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)秦氏馬蹄內翻足畸形分度：Ⅰ度9足，Ⅱ度17足，Ⅲ度14足。合并小腿內旋畸形9足，右側髖關節(jié)半脫位1例。采用有限軟組織松解與骨性截骨手術后，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。術后5～7 d開始矯正，以0.5～1.0 mm/d為宜；待踝關節(jié)矯正至過伸5～10°，足呈輕度外翻后停止牽伸，矯正位攜帶外固定架并負重行走4～6周。雙足畸形患者分兩期進行手術，手術間隔3～6個月，平均4個月。 結果 9足術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?；颊呔@隨訪，隨訪時間8個月～6年，平均37個月。牽拉矯形期間6例6足發(fā)生針道輕度感染，均經對癥處理后感染消失。術后2年1例1足畸形部分復發(fā)，經再次安裝Ilizarov外固定牽伸器負重行走4周，矯正滿意；其余畸形足在隨訪期內均獲得滿意矯正和全足底持重。末次隨訪時根據(jù)國際馬蹄足畸形研究會（ICFSG）的評分系統(tǒng)，獲優(yōu)28足，良10足，可2足，優(yōu)良率95%。 結論 有限矯形手術結合Ilizarov技術矯治青少年CCF，符合生物學原理和微創(chuàng)外科原則，安全、微創(chuàng)、療效確切。該馬蹄內翻足手術矯形策略遵循骨科自然重建理念，尤其適用于傳統(tǒng)矯形骨科手術難以治療的Ⅲ度CCF。
引用本文： 秦泗河,郭保逢,任龍喜,鄭學建,焦紹鋒. 有限矯形手術與Ilizarov技術治療青少年先天性馬蹄內翻足. 中國修復重建外科雜志, 2012, 26(1): 31-35. doi: 復制
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| 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, 鄭學建, 等. Ilizarov張力-應力法則結合三關節(jié)有限截骨矯正成年人重度馬蹄內翻足. 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. 關節(jié)牽伸器及Ilizarov技術矯治小腿肌攣縮致膝踝關節(jié)畸形. 中國組織工程研究與臨床康復, 2008, 12(39): 7636-7640．. |
- 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, 鄭學建, 等. Ilizarov張力-應力法則結合三關節(jié)有限截骨矯正成年人重度馬蹄內翻足. 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. 關節(jié)牽伸器及Ilizarov技術矯治小腿肌攣縮致膝踝關節(jié)畸形. 中國組織工程研究與臨床康復, 2008, 12(39): 7636-7640．.