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, 陈斌, 荆志振, 等. Ilizarov 技术矫治复杂僵硬性马蹄内翻足. 中华骨科杂志, 2012, 32(3): 222-228.
3.	毛宾尧. 严重马蹄内翻足的诊疗进展. 中国矫形外科杂志, 2012, 20(5): 422-424.
4.	秦泗河, 郭保逢, 任龙喜, 等. 有限矫形手术与 Ilizarov 技术治疗青少年先天性马蹄内翻足. 中国修复重建外科杂志, 2012, 26(1): 31-35.
5.	郑学建, 秦泗河, 郭保逢, 等. Ilizarov 踝关节弹性斜拉牵伸器在矫治重度马蹄足畸形中的应用. 中华创伤骨科杂志, 2015, 17(12): 1035-1041.
6.	中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑瘫康复专业委员会. 小儿脑性瘫痪的定义、分型和诊断条件. 中华物理医学与康复杂志, 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, 郑学建, 蔡刚, 等. Ilizarov 技术矫正足踝畸形的器械研究与临床应用. 中国矫形外科杂志, 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.	焦绍锋, 秦泗河, 郭保逢, 等. Ilizarov 技术结合有限手术治疗伴有皮肤溃疡的马蹄内翻足. 中国骨伤, 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, 罗毅, 高宇, 等. 跟腱延长及胫骨肌与肌腱移植修复脑瘫致马蹄内翻足: 恢复踝关节及足功能的评价. 中国组织工程研究, 2015, 19(2): 241-245.
19.	谢美明, 李伟, 谢庆云, 等. 改良经皮与开放跟腱延长术治疗跟腱挛缩症疗效比较. 中国修复重建外科杂志, 2013, 27(2): 164-168.
20.	陈业涛, 杨华清, 苗素华, 等. 儿童痉挛性脑瘫马蹄足的外科手术治疗策略. 中国矫形外科杂志, 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, 陈斌, 荆志振, 等. Ilizarov 技术矫治复杂僵硬性马蹄内翻足. 中华骨科杂志, 2012, 32(3): 222-228.
3. 毛宾尧. 严重马蹄内翻足的诊疗进展. 中国矫形外科杂志, 2012, 20(5): 422-424.
4. 秦泗河, 郭保逢, 任龙喜, 等. 有限矫形手术与 Ilizarov 技术治疗青少年先天性马蹄内翻足. 中国修复重建外科杂志, 2012, 26(1): 31-35.
5. 郑学建, 秦泗河, 郭保逢, 等. Ilizarov 踝关节弹性斜拉牵伸器在矫治重度马蹄足畸形中的应用. 中华创伤骨科杂志, 2015, 17(12): 1035-1041.
6. 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑瘫康复专业委员会. 小儿脑性瘫痪的定义、分型和诊断条件. 中华物理医学与康复杂志, 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, 郑学建, 蔡刚, 等. Ilizarov 技术矫正足踝畸形的器械研究与临床应用. 中国矫形外科杂志, 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. 焦绍锋, 秦泗河, 郭保逢, 等. Ilizarov 技术结合有限手术治疗伴有皮肤溃疡的马蹄内翻足. 中国骨伤, 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, 罗毅, 高宇, 等. 跟腱延长及胫骨肌与肌腱移植修复脑瘫致马蹄内翻足: 恢复踝关节及足功能的评价. 中国组织工程研究, 2015, 19(2): 241-245.
19. 谢美明, 李伟, 谢庆云, 等. 改良经皮与开放跟腱延长术治疗跟腱挛缩症疗效比较. 中国修复重建外科杂志, 2013, 27(2): 164-168.
20. 陈业涛, 杨华清, 苗素华, 等. 儿童痉挛性脑瘫马蹄足的外科手术治疗策略. 中国矫形外科杂志, 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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