马蹄足

Objective To explore the treatment of children congenital idiopathic clubfoot with combined operation.

目的探讨联合手术方法治疗小儿先天性马蹄内翻足。方法18例33足先天性马蹄内翻足患儿。

BACKGROUND: Ghildren refractory clubfoot includes idiopathic multiple contracture, untreated idiopathic clubfoot in older children and failure cases of repeated operations. It is very difficult to treat this type of children patients.

背景：儿童顽固性马蹄内翻足包括先天性多发性关节挛缩症、未经治疗的大年龄儿童先天性马蹄内翻足及反复手术治疗失败的病例，对该类患儿的治疗目前仍非常棘手。

PARTICIPANTS: Totally 3 cases of children idiopathic multiple contracture, 2 cases of idiopathic clubfoot in children aged more than 10 years old without treatment and 6 cases of postoperative recurrent idiopathic clubfoot were admitted by the Department of Orthopedics of Nanjing Children' s Hospital Affiliated to Nanjing Medical University during 1999 to 2000. All cases manifested abnormal ankylosis and shortening deformity in foot.

对象：1990/2000南京医科大学附属南京儿童医院骨科共收治儿童先天性多发性关节挛缩症3例、未经任何治疗10岁以上的大年龄儿童先天性马蹄内翻足2例、先天性马蹄内翻足术后复发6例，全部病例均表现为足畸形僵硬和短足畸形。

Club foot, or congenital talipes equinovarus, is a deformity of the ankle and foot that is present at birth.

马蹄内翻足，或先天性马蹄内翻足，是一种畸形的踝关节及足部这是目前在出生时。

［Objective］To explore the clinical efficiency,operative methods,apparatus assembly and postoperative administration of Ilizarov technique in the correction of talipes equinovarus.［Method］From January 2003 to May 2006,32 patients were corrected with QIN Si-he's orthotics devices on the Ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.

［目的］探讨Ilizarov技术矫正马蹄内翻足畸形的手术方法及器械改良、术后管理方法的改进及疗效［方法］2003年1月～2006年5月，根据Ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循Ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。

The results shows that HOXD13 gene mutation was not involved in outbreak in idiopathic congenital talipes equinovarus, but changes of HOXD13 and FHL1 gene expression related to the development of talipes equinovarus malformation.

上述结果说明：HOXD13的编码区突变可能不是先天性马蹄内翻足发生的原因，而HOXD13和 FHL1表达水平的改变可能与马蹄内翻足畸形的发生有关， HOXD13可能通过直接调控FHL1发挥作用。

For 9 patients (11 feet), 6 feets achieved excellent result, 4 feets good and 1 foot poor results respectively. Ilizarov technique in treatment of the severe rigid talipes equinovarus deformity achieves a good clinical result.

结论］Ilizarov外固定架三维矫正马蹄内翻足畸形效果确实，尤其适用于大年龄儿童之僵硬、复发或难治性马蹄内翻足，有一定的临床应用价值。

Ying was abandoned by his parents when he was only weight 3 pound ; Zou was abandoned by his parents more than 50 days after he was born, he has serious heart problems, pulmonary hypertension and facing life-threatening; Snow is a child with cerebral palsy and has been abandoned; Zhao has serious equinus varus ; Lu leads to congenital absence of anus, this has not yet one month old baby was found in the trash can , and when he was sent to the orphanage he was dying; Run had been abandoned in a county hospital, only because she is a cleft lip and palate baby...

党英被父母遗弃时体重只有三斤多点，蔫蔫的；小邹成出生后被父母遗弃在山东省邹城县医院的过道上长达50多天，严重的心脏病致使他心内膜垫完全缺损、肺动脉高压，面临生命危险；瑞雪是脑瘫患儿，出生时由于硬肿症送到医院抢救，半岁后孩子出现脑瘫迹象，所以被遗弃；赵恒有严重的马蹄足内翻；路通先天无肛，这个还没有满月的娃是在路边的垃圾桶里被人发现的，送到福利院时已经奄奄一息；润润曾经被遗弃在河南一个县城医院里，只因为这是一个唇腭裂的宝宝。。。

Ying was abandoned byhis parents when he was only weight 3 pound ; Zou was abandoned byhis parents more than 50 days after he was born, he has serious heart problems, pulmonary hypertension and facing life-threatening; Snow is a child with cerebral palsy and has been abandoned; Zhao has serious equinus varus ; Lu leads to congenital absence of anus, this has not yet one month old baby was found in the trash can , and when he was sent to the orphanage he was dying; Run had been abandoned in a county hospital, only because she is a cleft lip and palate baby...

党英被父母遗弃时体重只有三斤多点，蔫蔫的；小邹成出生后被父母遗弃在山东省邹城县医院的过道上长达50多天，严重的心脏病致使他心内膜垫完全缺损、肺动脉高压，面临生命危险；瑞雪是脑瘫患儿，出生时由于硬肿症送到医院抢救，半岁后孩子出现脑瘫迹象，所以被遗弃；赵恒有严重的马蹄足内翻；路通先天无肛，这个还没有满月的娃是在路边的垃圾桶里被人发现的，送到福利院时已经奄奄一息；润润曾经被遗弃在河南一个县城医院里，只因为这是一个唇腭裂的宝宝。。。

Method］from january 2003 to may 2006,32 patients were corrected with qin si-he's orthotics devices on the ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.among these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino-varus.in accordance with deformities,external fixator and limitied operative methods were dertermined.the limited release of soft tissue were performed in 7 patients,limited osteotomy in 25 patients.the dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength.according to the ilizarov technique,the fixative rods were installed.the telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensional directions.the deformity of talipes equinovarus,internal rotation and drooping of the forefoot were gradually corrected,and the patients could bear weight and walked on the deformed foot.the mean duration of traction were 42 days,then removed the external fixator maintained with plaster for a site time.

方法］2003年1月～2006年5月，根据ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7 d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准。在矫形的过程中定期进行x线检测，以防止发生踝关节前后移位，治疗期间允许患足负重行走。术后平均牵伸42 d，拆外固定器后患足再上石膏固定适当时间。

As she looked at Warrington's manly face, and dark, melancholy eyes, she had settled in her mind that he must have been the victim of an unhappy attachment.

每逢看到沃林顿那刚毅的脸，那乌黑、忧郁的眼睛，她便会相信，他一定作过不幸的爱情的受害者。

Maybe they'll disappear into a pothole.

也许他们将在壶穴里消失