摘要
目的探讨先天性僵硬型马蹄内翻足治疗方案的设计对远期足外形与功能的意义。方法102例166足先天性僵硬型马蹄内翻足患儿首次就诊住院进行正规康复治疗,6月龄时根据距跟角(T-CA)、跟骨-第一跖骨角(C-M_1A)、第一跖骨-内踝距离(M_1-ML)的改善程度采取不同手术方式(跟腱延长术,改良Turco术,胫前肌外置术),分析不同治疗方法临床疗效、距骨大小形态改变及其与预后的关系。结果①单纯康复治疗优良率85.7%,距骨畸变率11.4%;②治疗结束后1年,改良Turco术临床优良率90.0%,跟腱延长术为78.1%(P<0.01);而跟腱延长术疗效维持较差,下降12个百分点(P<0.01);改良Turco术距骨畸变率20.0%,跟腱延长术为18.8%(P>0.05);胫前肌外移术M_1-ML均值从29.9mm提高至35.3mm,而距骨畸变率21.1%,与改良Turco术比较,P>0.05;距骨畸变率与临床预后密切相关(相关系数r=0.874),与手术方式无明显相关性(相关系数r<0.05)。结论早期、持续康复治疗,改进手术方式,确切地保护跟、距、舟骨的血液循环,是重建足踝部生物力学,最大限度恢复和维持患足外形与功能的关键。
Objective To present our therapeutic strategy for children with congenital rigid clubfoot. Methods One hundred and two children （one hundred and sixty-six feet） with rigid congenital clubfoot were treated with rehabilitative therapy after birth. When patients were 6 months, Achilles tendon lengthening, modified Turco release, or tibialis anterior tendon transfer was performed according to the improvement of T-CA, C-M1A,M1-ML. The relationship between the deformities of the talus and the appearance and function of feet was compared and analyzed. Results ① The good-excellent rate of the rehabilitative therapy was 85.71%, and the talus deformity rate was 11.43 %. ② One year after operation, the good-excellent rate of modified Turco release was 90% while Achilles tendon lengthening was 78. 13%（P〈0. 01） . ③ The deformity rate of the talus in modified Turco release was 20% while it was 18. 75% in Achilles tendon lengthening （P〉0. 05）. ④ The value of M1 -ML in tibialis anterior tendon transfer raised from 29. 9 to 35.3 ram, and the deformity rate of the talus was 21.05%. ⑤ The deformity rate of the talus was closely related to the prognosis （correlation coefficient r= 0. 874,but it was not related to the operative means （correlation coefficient r〈0. 493）. Conclusions Continuous rehabilitative therapy and improvement of operative procedure to protect the blood circulation of calcaneus, talus and scaphoid bone are the key factors to rebuilt the biomechanics, appearance and function of the sick feet.
出处
《中华小儿外科杂志》
CSCD
北大核心
2007年第4期196-199,共4页
Chinese Journal of Pediatric Surgery
