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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 investigate the significance of design of long-term foot shape and function in the design of congenital and stiff type of clubfoot. Methods One hundred and two hundred and sixty feet of 166 children with congenital stiff type clubfoot were admitted to the hospital for the first time to receive regular rehabilitation. According to T-CA, C-M_1A, The first metatarsal-medial malleolus (M_1-ML) to improve the degree to take a different surgical approach (Achilles tendon extension, modified Turco surgery, anterior tibialis external surgery), analysis of different treatment methods of clinical efficacy, talar size and morphological changes and Prognosis of the relationship. Results ① The excellent and good rate of pure rehabilitation was 85.7% and the rate of distraction of talus was 11.4%. ②After 1 year of treatment, the excellent and good rate of modified Turco was 90.0% and the Achilles tendon extension was 78.1% (P <0.01) (P <0.01). The modified Turco’s talus ratio was 20.0% and the Achilles tendon extension was 18.8% (P> 0.05). The mean value of M_1-ML in anterior tibialis anterior mobilization ranged from 29.9 mm (P <0.05). The rate of distraction of the talus was closely related to the clinical prognosis (correlation coefficient r = 0.874), and there was no significant correlation with the surgical method (correlation coefficient r < 0.05). Conclusion In the early stage, it is the key to reconstruct the biomechanics of ankle and foot and to restore and maintain the appearance and function of the affected foot in the early stage of continuous rehabilitation, improving the surgical approach, and accurately protecting the blood circulation of the heel and scaphoid.