摘要目的 探讨反式Ponseti方法联合微创切开复位技术治疗先天性垂直距骨的治疗方法及临床疗效.方法 回顾性分析2012年7月至2015年12月就诊的先天性垂直距骨患儿11例(18足)的临床资料.其中,男8例,女3例;平均手术年龄10.9个月(3.9～31.2个月).所有患儿均行多次反式Ponseti序列石膏矫形,经皮逆行穿针固定或微创切开复位固定距舟关节,经皮延长跟腱,石膏固定治疗.比较患儿术前、术后即刻、末次随访时的影像学资料,及术前和末次随访的临床查体资料,用Adelaar评分和踝关节、距下关节活动度评估术后治疗情况.结果 11例(18足)患儿平均随访27个月(12～57个月),全部获得临床和影像学矫正,患儿足部内侧纵弓恢复,后足无明显外翻,踝关节和距下关节无明显功能障碍.有2例(4足)术后6个月内出现畸形复发,随后再次经序列石膏矫形、微创开放复位后畸形矫正,无需广泛松解手术.根据Adelaar评分,2足为优,15足为良,1足为中.所有患儿均无伤口坏死、关节僵硬等并发症.末次评估时,平均踝关节背伸达(20.89±9.28)度,平均跖屈达(18.50±6.89)度.本组末次随访与术前相比,前后位跟距角[(31.60±27.77)度VS.(49.65±13.00)度]、前后位距骨轴-第一跖骨基底角[(12.79±2.48)度VS.(42.90±18.01)度]、侧位跟距角[(44.57±6.71)度VS.(55.22±11.20)度]、侧位距骨轴-第一跖骨基底角[(9.39±2.83)度VS.(55.63±13.36)度]和侧位胫跟角[(67.14±5.71)度VS.(119.51±17.52)度]均有所改善,差异均有统计学意义(P＜0.05).结论 就足的临床外观、功能及影像学测量结果来看,反式Ponseti方法联合微创切开技术治疗先天性垂直距骨具有良好的早期临床效果.

abstractsObjective To explore the clinical efficacies and surgical of reverse Ponseti-type method plus mini-invasive approach for children with congenital vertical talus.Methods Between July 2012 and December 2015,11 consecutive patients with a total of 18 feet with congenital vertical talus were retrospectively reviewed after undergoing reverse Ponseti method plus mini-invasive approach.There were 8 boys and 3 girls with an average age of 10.9 (3.9-31.2) months.Serial manipulations and casting were followed by percutaneous Achilles tenotomy,casting or other limited procedures if necessary.They were evaluated clinically and radiographically at the time of presentation,immediately postoperatively and at the time of the latest follow-up.Also Adelaar scoring system and subtalar and ankle range of motion were used for evaluating clinical effects at the latest follow-up.Results All 18 feet achieved initial correction both clinically and radiographically during an average follow-up period of 27 (12-57) months.However,2 patients with 4 feet had recurrent deformity within 6 months of initial procedure and underwent serial manipulations and casting followed by pinning of talonavicular joint without an extensive soft-tissue release.According to the Adelaar scoring system,the outcomes were excellent (n =2),good (n =15) and fair (n =1).There was neither wound necrosis nor stiffness of ankle & subtalar joints.At the final evaluation,the mean ankle dorsiflexion was (20.89 ± 9.28)° and the mean plantar flexion (18.50 ± 6.89)°.Significant differences existed (P＜0.05) in all radiographic parameters,including AP-TCA (anteroposterior-talocalcaneal angle) [(31.60 ± 27.77)° vs (49.65 ± 13.00)°],AP-TAMBA (anteroposterior-talus axial-first metatarsal base angle) [(12.79 ± 2.48) vs (42.90± 18.01)];L-TCA (lateral-talocalcaneal angle) [(44.57 ± 6.71) vs (55.22 ± 11.20)],L-TAMBA (lateral-talus axial-first metatarsal base angle) [(9.40 ± 2.83) vs (55.63 ± 13.36)] and L-TICAA (lateral-tibiocalcanean angle) [(67.14 ± 5.71) vs (119.51 ± 17.52)] as compared with preoperative values at the latest follow-up.Conclusions In the terms of clinical appearance,foot function and radiographic measured results,reverse Ponseti-type method plus mini-invasive approach offers early excellent outcomes for congenital vertical talus.