Abstract
目的 探讨应用Ilizarov外固定支架治疗创伤性马蹄足的疗效.方法2003年2月～2005年8月应用Ilizarov外固定架治疗17例创伤所致马蹄足患者.将组装好的Ilizarov外固定架按照Ilizarov的穿针固定原则安装在患侧小腿和足部.术后3 d开始转动螺纹杆上的螺母,第1周旋转螺母2～4圈/d,4次/d;1周后旋转螺母1～2圈/d,4次/d,分别逐渐缩短和延长前、后螺纹杆,矫正马蹄足畸形.用伊氏架将踝关节固定在中立位2～3个月.去除外固定架后让患者逐渐增加负重量直至完全负重.不负重时穿戴支具保持踝关节处于中立位至少3个月.结果17例患者均得到随访,平均随访10个月(7～14个月).术后4～6周踝关节恢复到中立位.平均带外固定架14.5周(10～16周).无血管、神经损伤.3例各1处针道轻度感染,对症处理后感染消失.1例诉矫正过程中疼痛,术后10周去除外固定架,去除外固定架后6周时僵直在跖屈20°.1例去除外固定架4个月后僵直在跖屈10°.1例小腿前后肌群损伤严重合并胫骨骨缺损重建术后踝关节矫正到中立位后1.5个月行踝关节融合术,融合术后3个月去除外固定架.其余14例达到0°全足负重,行走时无明显足下垂.2例负重时疼痛.踝关节背伸肌群功能存在的患者,踝关节可主动背伸10°.结论Ilizarov外固定架是治疗创伤性马蹄足的微创技术。
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