| ObjectiveTo assess the therapeutic effect of Ilizarov external fixator combined with limited soft tissue release and muscle force balance and osteotomy for the treatment of cerebral palsy clubfoot deformity in adolescents,and to provide better treatment techniques and relevant basis for juvenile severe spastic clubfoot.MethodsA total clinical data of 41 patients(48 feet)met the selection criteria for this retrospective analysis study from June 2009 to September 2016.There were 23 males(26 feet)and 18 females(22 feet),34 cases with one side and 7 cases with both sides.The age range is 11 to 28 years old,with an average of 16.9 years.Preoperative classification was based on Diméglio scores: 19 feet were in grade II,16 in grade III,and 13 in grade IV.All patients were treated with anterior tibial muscle or posterior tibial muscle splitting and calcaneal tendon lengthening,medial plantar subcutaneous release and osteotomy was performed for some stiff clubfoot.At the same time,the residual deformity was corrected gradually using the Ilizarov external fixator.After 5-7 days of postoperative pain relief,gradually adjust the outer frame until a satisfactory form of ankle was achieved.All Ilizarov outer frame fixed at least 3 months,3 months after the timely removal of external fixation beginning to wear orthopedic brace,while practicing ankle flexion and extension exercise.Then reduce the time of day wear gradually until entirely abandon the orthosis.The data were statistically analyzed by the last follow-up ICFSG and MAS score compared with the preoperative score to get the result.ResultsAll 41 patients(48 feet)were followed up for 12-26 months(mean,19 months).After the removal of the outer frame,all the feet recovered to a plantar foot without nerve or vessel injury,and the results of the treatment were all satisfied.One foot was found red and swollen secretions at the nail tract at the 3 weeks after the operation,and the loosening of Kirschner's needle was considered,and the anti infection treatment was given and the Kirschner needle was strengthened and restored to normal.One foot had a slight inversion of front foot at 6 months after the removal of Ilizarov external fixator,showed a slight varus state,after prolong the wearing time of an orthopedic brace at the same time to perform rehabilitation exercise.There was no obvious abnormality in foot shape and gait for 12 months,without pain and other discomfort.One foot was found mild ectropion occurred during the follow-up period after 1 years' removal of the external frame.After rehabilitation treatment,and wearing the orthotic braces at night,the valgus was basically corrected at the last follow-up.The remaining 46 feet had no relapse of malformations during the follow-up phase.The last follow-up ICFSG score(6.83±5.79)was statistically different from the preoperative score(36.17±8.63),(p<0.05).The last follow-up ICFSG result was excellent in 38 feet,good in 6 feet,and moderate in 4 feet.The excellent and good rate was 91.67%.The difference between the last follow-up MAS score(1.40±0.68)and the preoperative score(2.69±0.72)was also statistically significant(p<0.05).ConclusionsIlizarov technique combined with limited operation in the treatment of juvenile cerebral palsy spastic clubfoot has attained reliable clinical effect,which have the following advantages:1.Minimally invasive,to minimize the damage to the soft tissue and do not affect the development of the foot,to avoid extensive soft tissue surgery on the foot vascular and nerve damage.2.A wide range of osteotomy or joint fusion is avoided,and the length of the foot and the degree of joint activity are retained.3.It does not affect the movement of the ankle joint postoperatively and avoids the muscle atrophy or nursing difficulty caused by the plaster external fixation.4.The patient can walk with weight as soon as possible,reshape and adapt to the new ankle force line and accelerate the recovery process. |
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