Ilizarov technique combined with limited surgery for correction of spastic clubfoot in adolescents with cerebral palsy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Chunzhi , WU Han , XIAO Peng ,  WU Xuejian

Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;

Corresponding?author：

WU Xuejian, Email: wuxuejianzz@126.com

Keywords：

Ilizarov technique; clubfoot; cerebral palsy; adolescent

DOI：

10.7507/1002-1892.201710045

Video：

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ObjectiveTo evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy.MethodsA retrospective analysis of clinical data of 29 cases (33 feet) of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male (20 feet) and 12 were female (13 feet) with an age range from 13 to 28 years (mean, 17.6 years). According to Diméglio classification, 19 feet were rated as gradeⅡ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external fixator, and the wearing time gradually reduced to completely abandon the brace.ResultsAll 29 patients (33 feet) were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group (ICFSG) score (5.21±3.91) was significantly lower than the preoperative score (36.73±4.80), and the difference was significant (t=47.227, P=0.000). The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness.ConclusionIlizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with appropriate soft tissue surgery according to the patient’s symptoms and signs.

Citation： GAO Chunzhi, WU Han, XIAO Peng, WU Xuejian. Ilizarov technique combined with limited surgery for correction of spastic clubfoot in adolescents with cerebral palsy. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 182-186. doi: 10.7507/1002-1892.201710045 Copy

1.	Lin CL, Lin CJ, Huang MT, et al. Mesh Achilles tendon lengthening–a new method to treat equinus deformity in patients with spastic cerebral palsy: surgical technique and early results. J Pediatr Orthop B, 2013, 22(1): 14-19.
2.	常峰, 陳斌, 荊志振, 等. Ilizarov 技術矯治復雜僵硬性馬蹄內翻足. 中華骨科雜志, 2012, 32(3): 222-228.
3.	毛賓堯. 嚴重馬蹄內翻足的診療進展. 中國矯形外科雜志, 2012, 20(5): 422-424.
4.	秦泗河, 郭保逢, 任龍喜, 等. 有限矯形手術與 Ilizarov 技術治療青少年先天性馬蹄內翻足. 中國修復重建外科雜志, 2012, 26(1): 31-35.
5.	鄭學建, 秦泗河, 郭保逢, 等. Ilizarov 踝關節彈性斜拉牽伸器在矯治重度馬蹄足畸形中的應用. 中華創傷骨科雜志, 2015, 17(12): 1035-1041.
6.	中國康復醫學會兒童康復專業委員會, 中國殘疾人康復協會小兒腦癱康復專業委員會. 小兒腦性癱瘓的定義、分型和診斷條件. 中華物理醫學與康復雜志, 2007, 29(5): 309.
7.	Diméglio A, Bensahel H, Souchet P, et al. Classification of clubfoot. J Pediatr Orthop Part B, 1995, 4(2): 129-136.
8.	秦泗河, 鄭學建, 蔡剛, 等. Ilizarov 技術矯正足踝畸形的器械研究與臨床應用. 中國矯形外科雜志, 2007, 15(8): 566-568.
9.	Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury, 2012, 43(11): 1969-1973.
10.	Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
11.	Limpaphayom N, Chantarasongsuk B, Osateerakun P, et al. The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome. Int Orthop, 2015, 39(8): 1593-1598.
12.	Reubens R, Silkwood-Sherer DJ.Intervention for an adolescent with cerebral palsy during period of accelerated growth. Pediatr Phys Ther, 2016, 28(1): 117-125.
13.	Tsang ST, McMorran D, Robinson L, et al. A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture, 2016, 50: 23-27.
14.	焦紹鋒, 秦泗河, 郭保逢, 等. Ilizarov 技術結合有限手術治療伴有皮膚潰瘍的馬蹄內翻足. 中國骨傷, 2015, 28(2): 145-149.
15.	Ganger R, Radler C, Handlbauer A, et al. External fixation in clubfoot treatment-a review of the literature. J Pediatr Orthop B, 2012, 21(1): 52-58.
16.	Fernandes RM, Mendes MD, Amorim R, et al. Surgical treatment of neglected clubfoot using external fixator. Rev Bras Orthop, 2016, 51(5): 501-508.
17.	Lee DY, Choi IH, Yoo WJ, et al. Application of the Ilizarovtechnique to the correction of neurologic equinocavovarus foot deformity. Clin Orthop Relat Res, 2011, 469(3): 860-867.
18.	郭景泉, 羅毅, 高宇, 等. 跟腱延長及脛骨肌與肌腱移植修復腦癱致馬蹄內翻足: 恢復踝關節及足功能的評價. 中國組織工程研究, 2015, 19(2): 241-245.
19.	謝美明, 李偉, 謝慶云, 等. 改良經皮與開放跟腱延長術治療跟腱攣縮癥療效比較. 中國修復重建外科雜志, 2013, 27(2): 164-168.
20.	陳業濤, 楊華清, 苗素華, 等. 兒童痙攣性腦癱馬蹄足的外科手術治療策略. 中國矯形外科雜志, 2013, 21(18): 1833-1836.
21.	Ryan JM, Cassidy EE, Noorduyn SG, et al. Exercise interventions for cerebral palsy. Cochrane Database Syst Rev, 2017, 6: CD011660.

1. Lin CL, Lin CJ, Huang MT, et al. Mesh Achilles tendon lengthening–a new method to treat equinus deformity in patients with spastic cerebral palsy: surgical technique and early results. J Pediatr Orthop B, 2013, 22(1): 14-19.
2. 常峰, 陳斌, 荊志振, 等. Ilizarov 技術矯治復雜僵硬性馬蹄內翻足. 中華骨科雜志, 2012, 32(3): 222-228.
3. 毛賓堯. 嚴重馬蹄內翻足的診療進展. 中國矯形外科雜志, 2012, 20(5): 422-424.
4. 秦泗河, 郭保逢, 任龍喜, 等. 有限矯形手術與 Ilizarov 技術治療青少年先天性馬蹄內翻足. 中國修復重建外科雜志, 2012, 26(1): 31-35.
5. 鄭學建, 秦泗河, 郭保逢, 等. Ilizarov 踝關節彈性斜拉牽伸器在矯治重度馬蹄足畸形中的應用. 中華創傷骨科雜志, 2015, 17(12): 1035-1041.
6. 中國康復醫學會兒童康復專業委員會, 中國殘疾人康復協會小兒腦癱康復專業委員會. 小兒腦性癱瘓的定義、分型和診斷條件. 中華物理醫學與康復雜志, 2007, 29(5): 309.
7. Diméglio A, Bensahel H, Souchet P, et al. Classification of clubfoot. J Pediatr Orthop Part B, 1995, 4(2): 129-136.
8. 秦泗河, 鄭學建, 蔡剛, 等. Ilizarov 技術矯正足踝畸形的器械研究與臨床應用. 中國矯形外科雜志, 2007, 15(8): 566-568.
9. Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury, 2012, 43(11): 1969-1973.
10. Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediatr Orthop B, 2006, 15(1): 34-36.
11. Limpaphayom N, Chantarasongsuk B, Osateerakun P, et al. The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome. Int Orthop, 2015, 39(8): 1593-1598.
12. Reubens R, Silkwood-Sherer DJ.Intervention for an adolescent with cerebral palsy during period of accelerated growth. Pediatr Phys Ther, 2016, 28(1): 117-125.
13. Tsang ST, McMorran D, Robinson L, et al. A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture, 2016, 50: 23-27.
14. 焦紹鋒, 秦泗河, 郭保逢, 等. Ilizarov 技術結合有限手術治療伴有皮膚潰瘍的馬蹄內翻足. 中國骨傷, 2015, 28(2): 145-149.
15. Ganger R, Radler C, Handlbauer A, et al. External fixation in clubfoot treatment-a review of the literature. J Pediatr Orthop B, 2012, 21(1): 52-58.
16. Fernandes RM, Mendes MD, Amorim R, et al. Surgical treatment of neglected clubfoot using external fixator. Rev Bras Orthop, 2016, 51(5): 501-508.
17. Lee DY, Choi IH, Yoo WJ, et al. Application of the Ilizarovtechnique to the correction of neurologic equinocavovarus foot deformity. Clin Orthop Relat Res, 2011, 469(3): 860-867.
18. 郭景泉, 羅毅, 高宇, 等. 跟腱延長及脛骨肌與肌腱移植修復腦癱致馬蹄內翻足: 恢復踝關節及足功能的評價. 中國組織工程研究, 2015, 19(2): 241-245.
19. 謝美明, 李偉, 謝慶云, 等. 改良經皮與開放跟腱延長術治療跟腱攣縮癥療效比較. 中國修復重建外科雜志, 2013, 27(2): 164-168.
20. 陳業濤, 楊華清, 苗素華, 等. 兒童痙攣性腦癱馬蹄足的外科手術治療策略. 中國矯形外科雜志, 2013, 21(18): 1833-1836.
21. Ryan JM, Cassidy EE, Noorduyn SG, et al. Exercise interventions for cerebral palsy. Cochrane Database Syst Rev, 2017, 6: CD011660.

Chinese Journal of Reparative and Reconstructive Surgery

Ilizarov technique combined with limited surgery for correction of spastic clubfoot in adolescents with cerebral palsy

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