Ilizarov技术联合经皮切腱术治疗儿童复发性先天性僵硬型马蹄内翻足

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Abstract Objective To evaluate the efficacy of modified Ilizarov technique in the treatment of recurrent congenital clubfoot with stiffness in children.Methods From June 2012 to September 2018，the Ilizarov technique was used to treat 25 children with recurrent stiff congenital clubfoot in Henan Children's Hospital，including 7 cases on the left foot，6 cases on the right foot，and 12 cases on both feet totaling 37 feet.There were 21 males and 4 females，among which one case with two feet already underwent transfer of the tibialis anterior tendon.The average age was (7.22±2.2)years old (range：3 years 4 months to 12 years old).On the basis of Ilizarov's ankle configuration，three fixation bolts of the internal and external screws along with the Ilizarov frame formed a micro-motion connection.The first metatarsal bone was cross stitched and percutaneous Achilles tenotomy or percutaneous gastrocnemius aponeurosis was conducted.Correction criteria consisted of complete arch correction，5° ~10° ankle valgus and 20° dorsiflexion.Results 37 feet of 25 cases reached the correction standard.At Ilizarov reconstruction and disassembly of fixation，tibialis anterior tendon was transferred to the third cuneiform in 6 cases and 9 feet.Fixation lasted 4~7 months with an average of (4.7±0.8)months.Complications included needle tract infections in 4 participants；valgus foot in 1 participant and 2 feet；steel needle splitting the calcaneus in 3 participants and 5 feet；and midfoot pain in 1 participant and 1 foot.Two participants with 3 feet were lost to follow-up.23 participants with 34 feet were followed up after removal of fixation from eleven months to eight and a half years，with an average follow-up period of (2.83±2.16)years.25 feet had normal gait and 7 feet had hallux adduction.According to the Garceau standard，the curative effect was evaluated as excellent in 27 feet，good in 7 feet.Two feet did not qualify for this standard due to valgus.Conclusion The Ilizarov technique can completely correct children's recurrent stiff congenital clubfoot.It is minimally invasive and has good aesthetics.

Key words： Ilizarov technique recurrent stiff congenital clubfoot

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