Liu Hang,Li Ming,Liu Xing,et al.Evaluations of plantar mechanics after mini-invasive soft tissue release of idiopathic clubfoot[J].Journal of Clinical Pediatric Surgery,2020,19(09):775-778.[doi:10.3969/j.issn.1671-6353.2020.09.003]
特发性马蹄内翻足微创软组织松解术后足底力学指标评价
- Title:
- Evaluations of plantar mechanics after mini-invasive soft tissue release of idiopathic clubfoot
- Keywords:
- Equinus Deformity/SU; Surgical Procedures; Minimally Invasive; Treatment Outcome; Mechanics
- 分类号:
- R726.8;R681.8;R682.1+6
- 摘要:
- 目的 采用足底形态扫描及静态足压评价DimeglioⅣ型特发性马蹄内翻足经微创多平面软组织松解术治疗后的短期疗效。方法 选取2016年1月至2018年6月于重庆医科大学附属儿童医院首诊并接受微创多平面软组织松解术治疗的Dimeglio Ⅳ型特发性马蹄内翻足病例共17例（25足）为病例组，其中男12例（18足），女5例（7足），手术年龄为1个月23天至6个月21天，评价年龄2岁5个月至2岁11个月；同期选取同年龄段健康儿童10人（20足）为对照组。采用Dimeglio评分、X线摄影、足底形态扫描分析、静态足压分析评价患足恢复情况。结果 Dimeglio Ⅳ型特发性马蹄内翻足经微创多平面软组织松解术系列治疗后Dimeglio评分0~2分；患足外观恢复满意。X线片显示：术前正位跟距角（14.90±3.20）°，术后正位跟距角（33.51±7.52）°；术前侧位跟距角（22.65±6.10）°，术后侧位跟距角（33.08±4.12）°；差异均具有统计学意义（P<0.05）。患儿足弓指数（0.35±0.02），正常对照组儿童的足弓指数（0.35±0.01），差异无统计学意义（P>0.05）；患儿双踝角（82.03±6.20）°，正常对照组双踝角（85.27±3.49）°，差异无统计学意义（P>0.05）。术后双侧马蹄内翻足双足压力分布百分比[（52.75±2.32）%vs.（47.25±2.32）%，P<0.05]以及术后单侧马蹄内翻足双足压力分布百分比[（60.33±4.54）%vs.（39.70±4.55）%，P<0.05]，差异均有统计学意义。结论 微创多平面软组织松解术治疗Dimeglio Ⅳ型特发性马蹄内翻足畸形矫正满意，短期疗效肯定。足底力学评价结果可以作为马蹄内翻足术后针对性治疗策略的重要参考指标。
- Abstract:
- Objective To evaluate the short-term efficacies of mini-invasive multiplanar soft tissue release for Dimeglio grade Ⅳ idiopathic clubfoot by plantar scan and static plantar pressure. Methods From January 2016 to June 2018,17 cases (25 feet) of Dimeglio grade IV idiopathic clubfeet underwent mini-invasive multiplanar soft tissue releasing.There were 12 boys (18 feet) and 5 girls (7 feet).The operative age range was from 53 to 201 days and the evaluation age 29 to 35 months.The recovery status of clubfeet was evaluated by Dimeglio score,radiography,plantar scan and static plantar pressure analysis. Results Dimeglio scores were 0-2 points after serial casting and mini-invasive multiplanar soft tissue releasing and the appearance of affected feet was satisfactory.Radiography indicated that preoperative and postoperative anteroposterior talocalcaneal angle was 14.90±3.20°,33.51±7.52°respectively and lateral talocalcaneal angle 22.65±6.10°,33.08±4.12°.The differences were statistically significant (P<0.05).The arch indices were 0.35±0.02 and 0.35±0.01.There was no significant inter-group difference (P>0.05).The bimalleolar angles were 82.03±6.20° and 85.27±3.49°.There was no significant difference (P>0.05).The distribution percentage of pressures in bilateral talipes equinovarus was[(52.75±2.32)%:(47.25±2.32)%,P<0.05]and that of unilateral talipes equinovarus[(60.33±4.54)%:(39.70±4.55)%,P<0.05]. Conclusion Mini-invasive multiplanar soft tissue release is efficacious for idiopathic clubfoot of Dimeglio grade Ⅳ.The outcomes of plantar mechanic evaluations may be used as an important reference for targeted maintenance therapeutics of clubfoot.
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备注/Memo
收稿日期:2020-04-18。
基金项目:国家临床重点专科建设项目（编号：国卫办医函[2013]544）
通讯作者:李明,Email:LM3180@163.com