微创多平面软组织松解术治疗先天性 马蹄内翻足的短期疗效

Short-term efficacy of minimally invasive multi-planar soft tissue lysis in treatment of congenital clubfoot

摘要:

目的：探讨微创多平面软组织松解术治疗先天性马蹄内翻足的短期疗效。方法：回顾性分析本院2014年7月至2017年6月采用微创多平面软组织松解术治疗的32例（45足）先天性马蹄内翻足患儿，收集治疗前和最近一次随访的Dimeglio评分和X片6个角度参数，比较治疗前后疗效，相关性分析评价Dimeglio评分与角度的关系。结果：本组所有病例均获得随访，平均随访（12.6±4.8）个月（最小6.2个月，最大24.9个月），最近一次随访中位Dimeglio评分为2.0（1，3）分，较治疗前明显改善（P=0.000）。X片的6个角度均有明显变化（P<0.05），相关性分析提示正位距骨-第1跖骨角与Dimeglio评分呈正相关（系数为r=0.346，P=0.020）。结论：微创多平面软组织松解术治疗先天性马蹄内翻足手术创伤小，术后疤痕不明显，踝关节功能及柔韧性良好，近期疗效满意。aminotransferase，AST）、丙氨酰氨基转移酶（alanyl aminotransferase，ALT）及天门冬氨酸氨基转移酶与血小板计数比（aspartate aminotransferase to platelet ratio index，APRI）指数之间差异均具有统计学意义（P<0.05）。HA、PC-Ⅲ、Ⅳ-C、LN和AST指标对预测肝硬化的曲线下面积（AUC）分别为0.910、0.804、0.833、0.753、0.730。HA、PC-Ⅲ、Ⅳ-C与Child-Pugh分级呈高度正相关（r>0.7，P<0.01），APRI与分级呈显著性正相关（0.4

Abstract:

Objective：To investigate the short-term efficacy of minimally invasive multi-planar soft tissue lysis in the treatment of congenital clubfoot. Methods：A retrospective analysis was performed on 32 patients（45 feet） with congenital clubfoot who underwent minimally invasive multi-planar soft tissue lysis in our hospital from July 2014 to June 2017. The Dimeglio scores and the degrees of six angles on X-ray before treatment and at the last follow-up were collected. The efficacy was evaluated and the correlations between Dimeglio score and degrees of six angles were analyzed. Results：All patients were followed up for （12.6±4.8） months（ranged from 6.2 to 24.9 months）. The median Dimeglio score at the last follow-up was 2.0（1，3），which was significantly better than that before treatment（P=0.000）. There were significant changes in the degrees of six angles on X-ray after treatment（P<0.05）. Only the degree of the anteroposterior talus-first metatarsal angle was positively correlated with Dimeglio score（r=0.346，P=0.020）. Conclusion：Minimally invasive multi-planar soft tissue lysis has good short-term efficacy because of its minimal invasion，unobvious postoperative scar，and good outcomes in ankle joint function and flexibility in the treatment of congenital clubfoot. cirrhosis，and 90 had Child-Pugh class C cirrhosis，and 35 individuals who under－went physical examination during the same period of time were enrolled as controls. The indices including liver function parameters，liver fibrosis indices，and platelet count were measured and analyzed. Results：There were significant differences between the two groups in hyaluronic acid（HA），laminin（LN），type Ⅲ collagen（PC-Ⅲ），type Ⅳ collagen（Ⅳ-C），aspartate aminotransferase（AST），alanine aminotransferase（ALT），and aspartate aminotransferase-to-platelet ratio index（APRI）（P<0.05）. HA，PC-Ⅲ，Ⅳ-C，LN，and AST had an area under the ROC curve of 0.910，0.804，0.833，0.753，and 0.730，respectively. HA，PC-Ⅲ，and Ⅳ-C were positively correlated with Child-Pugh class（r>0.7，P<0.01），and APRI was positively correlated with Child-Pugh score（0.4