文档介绍：1 改良 Ilizarov 技术结合有限手术矫正马蹄内翻足畸形作者:刘春枝,秦泗河,母心灵,郭小伟,王贞艳【摘要】[目的]探讨 Ilizarov 技术矫正马蹄内翻足畸形的手术方法及器械改良、术后管理方法的改进及疗效。[方法] 2003 年1 月~ 2006 年5月, 根据 Ilizarov 张力应力法则, 应用秦泗河改良的外固定矫形器, 遵循 Ilizarov 穿针固定的基本原则, 共手术治疗马蹄内翻足 32例,男 15例,女17 例; 年龄 10~ 25岁, 平均 17岁。病因: 腓总神经损伤 2例, 腰椎管内肿瘤 1 例,硬脊膜膨出 5 例,小儿麻痹后遗症 11 例,先天性马蹄内翻足 13 例。术前用足掌的前外缘负重行走者 11例, 用足的外缘或足背外侧负重者 21例。根据马蹄内翻足畸形程度、性质和患者年龄, 确定实施有限矫形手术的方法和外固定矫形器治疗。本组 7 例同期实施有限的软组织松解术, 25 例同期实施了有限的截骨术和跗骨间关节融合术, 9 例合并踝关节内外翻肌力明显失衡者,同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序, 7d 开始旋转相应的螺纹牵拉杆,对器械 2 进行三维空间的缓慢调整,先矫正前足内收和后足内翻,后矫正足下垂畸形, 直至达到矫形要求的标准。在矫形的过程中定期进行 X 线检测, 以防止发生踝关节前后移位, 治疗期间允许患足负重行走。术后平均牵伸 42d, 拆外固定器后患足再上石膏固定适当时间。[结论] 32 例患者术后均获得随访,其中 26 例为来院复查。随访时间 1 年~ 3年1 个月,平均1年5 个月。畸形均获满意矫正,足持重行走功能良好, 患者满意。本组无 1 例发生严重针道感染和切口感染, 未并发踝关节脱位及血管、神经损伤等并发症。[结论]改良 Ilizarov 技术矫正马蹄内翻足畸形, 手术创伤小、安全, 治疗效果提高, 配合有限矫形手术, 能够矫正传统矫形手术难以治疗的严重足畸形, 缩短治疗周期, 避免了严重手术并发症。【关键词】 Ilizarov; 张力- 应力法则; 外固定器; 马蹄内翻足; 矫形手术 Abstract :[ Objective ] To explore the clinical efficiency,operative methods,apparatus assembly and postoperative administration of Ilizarov technique in the correction of talipes equinovarus. [ Method ] From January 2003 to May 2006,32 patients were corrected with QIN Si-he ’s orthotics devices on the Ilizarov principle of tension-stress, 3 which involved 15 males and 17 females,the age ranged from 10 to 25 these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino- accordance with deformities,external fixator and limitied operative methods were dertermined. The limited release of soft tissue were performed in7 patients,limited osteotomy in 25 dynamic muscle balance operation were performed in9 patients with imbalance of muscle to the Ilizarov technique,the fixative rods were telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensiona