双踝角测量及在先天性马蹄内翻足治疗中的应用

1、双踝角测量及在先天性马蹄内翻足治疗中的应用         08-07-04 15:43:00     编辑：studa20             作者：杨璇 陈挺 范青 张自明 陆美玲 杜青 张菁  【关键词】  双踝角摘  要：目的报道对正常婴幼儿足双踝角（FBM）的研究，并总结应用双踝角对先天性马蹄内翻足患儿病变程度进行

2、分类与治疗评估的经验。方法测量足印长轴与内外踝的内上夹角为双踝角。2002年6月2004年4月，测量正常儿140足(70人)，测量马蹄内翻足患儿60足(30人)。结果正常组婴幼儿足印双踝角平均865°，马蹄内翻足患儿足印FBM：类FBM角平均732°；类FBM角平均665°；类FBM角平均547°。所有经保守治疗成功病例治疗后FBM角平均844°，基本接近正常婴幼儿FBM值；先保守治疗再手术软组织松解的病例，术后FBM角平均785°，外观基本满意。其中全部类、80类和30类患足均经保守治疗获得满意疗效，20类和70类患足经保守治疗后因

3、畸形矫正欠佳，再行软组织松解手术。结论采用FBM角对婴幼儿马蹄内翻足患儿畸形程度进行分类和治疗效果的评价是一种操作简便、客观、可重复使用的临床分类及评估标准，对于婴幼儿马蹄内翻足治疗前的评估和治疗方法的选择具有实际使用意义。关键词：马蹄足；  双踝角；  足印Application of foot bimalleolar measurement in the treatment of congenital talipes equinovarusAbstract：ObjectiveTo study the measuring result of normal foot bim

4、alleolar(FBM）angel in infants,and explore its application in the evaluation and identification of congenital talipes equinovarus pre and postoperativelyMethodThe anteromedial angle between the long axis of foot and bimalleolar plane was measured as the FBM angleFrom June 2002 to April 2004,140 healt

5、hy feet of 70 infants aged from burn to 12 months were measured for FBMFBM angle of another 60 equinovarus feet of 30 infants with similar ages were measured for comparison and evaluationResultFBM angle of all healthy feet was average 865For the talipes equinovarus feet,the preoperative FBM angles w

6、ere:average 732 in grade ;665 in grade ;547 in grade After surgical treatment,the FBM angle reached to average 844 in cases receiving successful conventional treatment,which was quite close to the normal value;the FBM angle reached to average 785 in cases receiving conventional treatment and soft ti

7、ssue releaseSatisfactory result was achieved in all type cases,80% of type cases and 30% of type cases respectivelyExtra procedure of soft tissue release was given in the rest 20% of grade and 70% of grade ConclusionFBM measurement is a simple,objective and repeatable method for the clinical classif

8、ication and evaluation of clubfootIt has significant importance in the treatment of talipes equinovarus,especially in the evaluation and method selection before treatmentKey words：Clubfoot;  FBM angle;  Foot tracing    先天性马蹄内翻足(congenital talipes equinovarus or congenital cl

9、ubfoot)是一种常见的先天性多发畸形，婴儿出生即可见患足内翻、前足内收、踝马蹄、胫骨内旋，本病的病因学说繁多，有认为距骨畸形为原发变化，软组织挛缩为继发性改变；亦有认为距下跟骨旋转为原发病变，但尚未有定论，对于CCF分类与对畸形严重程度的分类方法国际上有多种，本文通过介绍对正常婴幼儿足双踝角的研究，并应用双踝角对先天性马蹄内翻足患儿病变程度进行分类与治疗评估。1  临床资料11  方  法将足保持跖屈位，印下足印同时标记内踝、外踝，测量足印长轴(足跟与第2趾连线)与内外踝连线的内上夹角为双踝角(FBM角)。2002年6月2004年4月，测量正常儿140足(70

10、人)，出生012个月(平均56个月)，男35人(70足)，女35人(70足)，计算正常儿童双踝角平均值。测量马蹄内翻足患儿56足(30人)，出生4 d12个月，男22人(703)，女8人(297%)，并按临床表现的畸形程度分为3类：类：手法可以被动纠正畸形(6足)；类：手法被动矫正后马蹄内翻固定畸形20°(24足)；类：手法被动矫正后马蹄内翻固定畸形20°(26足)。测得每一分类的FBM角度全部马蹄内翻足患儿就诊后即行手法和石膏矫形治疗(Ponseti方法)，每13周更换石膏1次，同时记录FBM角。经过治疗内收、内翻纠正，被动矫形下中和位无阻力，记录3次FBM角无减小，改用矫形支具；若经过石膏矫形治疗外观仍有马蹄、内翻、内收畸形，记录3次FBM角无明显改变，则行手术矫正。12  结  果测得正常组婴幼儿足印双踝角平均865°。马蹄内翻足患儿足印FBM：类FBM角平均732°；类FBM角平均655°；类FBM