| Objective: To compare and analyze the effectiveness of Ilizarov external fixator combined with limited orthopedic surgery and Taylor space external fixator combined with limited orthopedic surgery in the treatment of adult rigid talipes equinovarus,so as to provide reference for the selection of surgical methods for adult rigid talipes equinovarus.Methods: A total of 78 adult patients with rigid talipes equinovarus treated with Ilizarov external fixator and Taylor space external fixator in our hospital from January2017 to January 2022 were retrospectively analyzed.The surgery-related data,duration of correction,degree of correction at 1 year after operation,clinical efficacy at 1 year after operation,and postoperative complications were compared and analyzed between the two groups.Results: A total of 78 patients were followed up for 12 to 18 months.There was no significant difference in the follow-up time between the Ilizarov ring fixator group(IRF group)and the Taylor spatial frame group(TSF group)(P>0.05).The foot and ankle deformities were corrected and the foot and ankle function was improved in both groups.There was no significant difference in operation duration and intraoperative blood loss between the two groups(P>0.05).In IRF group,the external frame adjustment time was 8-16 weeks,with an average of 11.33±2.46 weeks,and the frame wearing time was 15-21 weeks,with an average of 17.95±1.88 weeks.In TSF group,the external frame adjustment time was 5-13 weeks,with an average of8.77±2.76 weeks,and the wearing time was 11-19 weeks,with an average of14.90±2.76 weeks.The duration of external frame adjustment and wearing in the TSF group were shorter than those in the IRF group,and the differences were statistically significant(P<0.05).In IRF group,the anteroposterior talocalcaneal Angle ranged from 28.2 ° to 36.6°(mean,32.37±2.99°)and the lateral talocalcaneal Angle ranged from 37.9 ° to 48.5°(mean,42.69±3.37°)at 1 year after operation.In TSF group,the anteroposterior talocalcaneal Angle ranged from 30.7-37.8 °(mean,34.37±2.47°)and the lateral talocalcaneal Angle ranged from 40.0-50.3 °(mean,44.85±3.28°)at 1 year after operation.The anteroposterior talocalcaneal Angle and lateral talocalcaneal Angle in the two groups were significantly improved when compared with those before operation(P<0.05),and returned to the normal range.The correction degree of anteroposterior talocalcaneal Angle and lateral talocalcaneal Angle in TSF group was better than that in IRF group at 1 year after operation,and the difference was statistically significant(P<0.05).At 1 year after operation,the American Orthopaedic Foot and Ankle Society Scale(AOFAS)scores of the two groups were significantly higher than those before operation(P<0.05).The AOFAS score of IRF group ranged from 43 to 92 points,with an average of 78.95±13.31 points(excellent in 17 cases,good in 16 cases,fair in 4 cases,poor in 2 cases).One year after operation,the AOFAS score of TSF group ranged from 46 to 96 points,with an average of85.03±12.55 points(excellent in 18 cases,good in 17 cases,fair in 5 cases,poor in 3cases).The AOFAS score of TSF group was better than that of IRF group at 1 year after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the excellent and good rate between the two groups(P>0.05).One year after IRF,the SF-36 score ranged from 66.8 to 82.2,with an average of75.10±4.94.The SF-36 score of TSF group 1 year after operation ranged from 78.4 to99.0,with an average of 90.41±5.94.The SF-36 quality of life score of TSF group was better than that of IRF group at 1 year after operation,and the difference was statistically significant(P<0.05).Pin tract infection,talus displacement,claw toe,deformity recurrence,ankle stiffness,osteoarthritis and other postoperative complications occurred in some patients in both groups,which were common complications in the process of correcting clubfoot deformity with external fixator.Postoperative complications occurred in 26 patients(60.5%)in the IRF group and 13patients(33.3%)in the TSF group.The proportion of postoperative complications in TSF group was lower than that in IRF group,and the difference was statistically significant(P<0.05).Conclusion: Ilizarov external fixator or Taylor space external fixator combined with limited orthopedic surgery is effective in the treatment of adult rigid clubfoot.However,compared with Ilizarov external fixator,Taylor space external fixator has shorter adjustment time and wearing time,better deformity correction effect,and lower proportion of postoperative complications.Thus,the Taylor space external fixator performs better than the Ilizarov external fixator in the correction of rigid clubfoot in adults. |
PDF Full Text Request