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目的回顾性分析微创Carroll术式治疗DimeglioⅢ、Ⅳ型先天性马蹄内翻足的短期疗效。方法选取2014年7月至2016年1月于本院首诊的DimeglioⅢ、Ⅳ型先天性马蹄内翻足患儿,共27例33足,其中男性18例(22足),女性9例(11足)。年龄3个月至3岁。均采用微创Carroll术式(取足跟部、足内侧、足底短小切口,手法复位跟距关节、距舟关节)治疗,并以长腿管型石膏固定6~8周。所有患儿术后1周换药,术后1、2、3个月复查,之后每隔6个月复查,根据Dimeglio评分、Pirani评分、X线及功能标准评价患足恢复情况。结果微创Carroll手术使患足的后侧、内侧及足底均获得了满意松解,畸形矫正充分,切口长度0.5~1.0 cm;经3~18个月随访,患足功能恢复满意,根据Dimeglio评分、Pirani评分、X线检查及踝关节功能标准进行评价:优,20例25足,占75.76%;良,5例6足,占18.18%;一般,2例2足,占6.06%。优良率93.94%。无并发症发生,瘢痕不明显。结论微创Carroll手术治疗DimeglioⅢ、Ⅳ型先天性马蹄内翻足可充分矫正畸形,并发症少,切口愈合良好。
Objective To retrospectively analyze the short-term curative effect of minimally invasive Carroll procedure for the treatment of dimeglio Ⅲ and type Ⅳ congenital clubfoot. Methods A total of 27 patients (33 feet) with Dimeglio Ⅲ and Ⅳ congenital clubfoot were selected in this hospital from July 2014 to January 2016. There were 18 males (22 feet) and 9 females (11 cases) foot). Age 3 months to 3 years old. All patients were treated with minimally invasive Carroll technique (taking the heel and foot, the medial side of the foot, the short incision of the foot, the reduction of the approach and the distance from the joint and the armpit joint), and fixed them for 6 to 8 weeks with long-legged cast plaster. All children underwent dressing change 1 week after operation, and were reviewed after 1, 2 and 3 months after operation. The patients were reviewed every 6 months and evaluated for foot recovery according to Dimeglio score, Pirani score, X-ray and functional criteria. Results The minimally invasive Carroll operation made the posterior, medial, and plantar feet of the affected foot satisfactorily released and had adequate deformity correction. The incision length ranged from 0.5 cm to 1.0 cm. After 3 to 18 months of follow-up, satisfactory functional recovery was obtained. According to Dimeglio Pirani score, X-ray examination and ankle joint function criteria were evaluated: excellent, 20 cases of 25 feet, accounting for 75.76%; good, 5 cases of 6 feet, accounting for 18.18%; in general, 2 cases of 2 feet, accounting for 6.06%. Excellent rate of 93.94%. No complications, scar is not obvious. Conclusion Minimally invasive Carroll surgery for Dimeglio Ⅲ, Ⅳ congenital clubfoot can correct deformity, fewer complications, incision healed well.