Ilizarov Technique For The Treatment Of Severe Clubfoot

Background: Horseshoe varus is one of the most common deformities in children's orthopedics.Most of them are congenital and neurogenic,and a few are traumatic.The main clinical manifestations are ankle joint flexion,heel varus,and forefoot adduction.The horseshoe is named after it.Among them,the incidence of congenital clubfoot is the highest,reaching more than 1‰.The symptoms of clubfoot are mainly due to the contracture of soft tissue,and the patient's condition,such as the formation of skeletal deformities,gradually increases with age,eventually forcing the patient to walk or even stand,which brings extremes to the patient's daily life and work.Great inconvenience.With the development of medical technology and the popularization of health knowledge,most parents have continuously improved their understanding of clubfoot.Children with clubfoot before the age of 1 can be reset by related techniques,such as plaster and brace.Conservative treatment to significantly improve deformity and even cure.However,some patients still suffer from the lack of timely treatment,or the failure of early orthopedic treatment,which makes the condition continue to worsen.The clubfoot of these children is mainly traumatic and neurogenic,and is older and more deformed.Conservative treatment has not achieved good results.At the same time,in the clinical treatment of such patients,prone to infection,skin refractory ulcer,scar contracture and stiffness of joints,residual local deformity,muscle atrophy and muscle imbalance,etc.,bring clinical treatment Great difficulties and challenges.At the same time,adult patients with clubfoot have long been ill,and have missed the best time for conservative treatment,and the condition is more serious,and the treatment process is more complicated.Such patients often suffer from severe stiffness and deformity of the affected limb,even through traditional surgical methods,such as local lysis,osteotomy or the like,it is difficult to achieve satisfactory results,and may also increase the patient's psychological stress and economic pressure.Ilizarov external fixator technology based on the "tension-stress" principle has been widely recognized and used in the treatment of severe deformities of the extremities.The principle of the "tension-stress" rule is: under the tension of the outside,it can promote the regeneration and repair of blood vessels,bones,muscles and other tissues.Therefore,this study used Ilizarov external fixator orthopedic technique to treat older underage(>6 years old)and adult patients with severe clubfoot.Methods: 1.Collect 14 patients(17 feet)with severe clubfoot in the Department of Orthopaedic Surgery,the First Affiliated Hospital of Guangxi Medical University from December 2014 to September 2018.The clinical data(name,gender,age,Retrospective analysis was performed on the left and right feet.2.Inclusion criteria:(1).According to Dimeglio classification method Type III(severe)or above;(2).Previously conservative treatment is ineffective or poorly effective;3.Patients who miss the best time for conservative treatment.Exclusion criteria:(1).Patients with mental disorders can not cooperate with the adjustment and care of the external fixation;(2).Do not follow the doctor's advice to adjust the external fixation frame and do not wear orthopedic shoes after surgery;(3).Remove the external fixation frame in advance(4).Can not tolerate the operator.3.Patients were scored according to the ISFSG scoring criteria before and after surgery.The curative effect was determined by analyzing the preoperative and postoperative scores.Results: 1.After treatment,all patients were followed up for evaluation.The efficacy was excellent: 14 feet,good 3 feet,excellent rate of 100%;congenital clubfoot was excellent 8 feet,good 1 foot;non-innate Sexual clubfoot was excellent in 6 feet,good in 2 feet.Compared with the excellent rate after treatment of the two types,the chi-square test was used,and the difference was not statistically significant(P=0.576).2.The ICFSG scores before and after treatment were compared.The median score of the congenital group before treatment was 46.00,which was higher than the median score of 2.00 after treatment.The difference between the ICFSG scores of the congenital group and the fisher's test was statistically significant.Z=-2.666,P=0.008).The median score of pre-treatment scores in the non-innate group was 43.50,which was higher than the median score of 4.00 after treatment.The difference in ICFSG scores between the congenital group and the patients before and after treatment was statistically significant(Z=-2.530,P=0.008).).3.Compared with the ICFSG scores before treatment,there was no significant difference in fisher's test between the two groups(Z=-0.627,P=0.531).There was no significant difference in fisher's test between the two groups after treatment(Z=-1.965,P=0.049).Conclusions: 1.This study considers that the Ilizarov external fixator is effective in treating severe clubfoot deformities.2.The Ilizarov external fixator has a significant advantage over traditional treatments in the treatment of severe clubfoot.3.Postoperative complications of Ilizarov external fixation can be avoided by preoperative rigorous surgical design,fine intraoperative procedures,and good postoperative care and careful follow-up.4.Ilizarov external fixator orthopedic technique for the treatment of severe clubfoot is a good technique with few complications and light weight,and is worthy of clinical use.