Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZANG Jiancheng ^1,2,3 ,  QIN Sihe ^1,2,3 , QIN Xulei ^1,2,3 , SHI Lei ^1,2,3 , LÜ Zeping ^1,2,3

1. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;
2. Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, P.R.China;
3. Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, 100176, P.R.China;

Corresponding author：

QIN Sihe, Email: qinsihe@163.com

Keywords：

External fixation; Ilizarov technology; spina bifida; ankle malformation; flail foot; Charcot arthropathy

DOI：

10.7507/1002-1892.201808076

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Objective To summarize the main methods and comprehensive effects of limited surgery combined with external fixation for the treatment of flail foot with sensory disorder of spina bifida sequela in adult. Method The clinical data of 22 cases (30 feet) of the adult spina bifida sequela who suffered from flail foot with sensory disorder and treated by limited surgery combined with external fixation were retrospectively analysed between January 2005 and December 2015. There were 14 males and 8 females with an age of 8-38 years (mean, 21.5 years). All 30 feet were distal ankle sensory loss, including 2 cases (2 feet) on the left side, 2 cases (2 feet) on the right side, and 18 cases (26 feet) on both sides. There was 1 foot accompanied by ulcerative plantar ulcers, and 3 feet lost their toes due to foot osteomyelitis in the weight-bearing area. Combined with 3 cases of hip dislocation, 3 cases of scoliosis, 4 cases of knee deformity, and 3 cases of ptosis. There were 5 cases of normal control of urine and stool, 10 cases of partial control of urine and stool, 6 cases of overflow urinary incontinence, and 1 case of cystostomy. According to X-ray film, the lesion of spina bifida was evaluated, the laminar insufficiency was located at L₃-L₅ in 8 cases, L₅, S₁ in 9 cases, and L₃-S₃ in 5 cases. In the patients, 12 feet were performed ankle joint arthrodesis, 10 feet subtalar arthrodesis, and 8 feet tibia-talus-calcaneus arthrodesis. Ilizarov external fixator was used in 18 feet, Hybrid fixator in 8 feet, Hybrid fixator and cannulate screws in 3 feet, and Ilizarov fixator and cannulate screws in 1 foot. Results All 22 patients were followed up 10-80 months (mean, 48.5 months). All ankle deformities were corrected effectively after operation, the middle and hind feet were stable, the plantar foot was restored, the whole foot was loaded, and the ulcer healed without recurrence. There were 2 cannulate screws ruptured in the subtalar arthrodesis, bone healed after screws break; no complication such as surgical infection, neurovascular injury, and so on happened. At last follow-up, based on the evaluation criteria of QIN Sihe lower limb deformity correction, the results were excellent in 15 feet, good in 9 feet, and fair in 6 feet, with an excellent and good rate of 80.0%. Conclusion The treatment of flail foot with sensory disorder of spina bifida sequela is more demanding. The limited surgeries combined with external fixation play an important role for recovering the stability of foot and ankle, better clinical results, and less complications.

Citation： ZANG Jiancheng, QIN Sihe, QIN Xulei, SHI Lei, LÜ Zeping. Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1255-1260. doi: 10.7507/1002-1892.201808076 Copy

1.	秦泗河, 葛建忠, 郭保逢. 脊椎裂后遗足踝畸形的临床分析. 中华外科杂志, 2010, 48(12): 900-903.
2.	Latt LD, Smith KE, Dupont KM. Revision tibiotalocalcaneal arthrodesis with a pseudoelastic intramedullary nail. Foot Ankle Spec, 2017, 10(1): 75-81.
3.	Crawford B, Watson JT, Jackman J, et al. End-stage hindfoot arthrosis: outcomes of tibiocalcaneal fusion using internal and Ilizarov fixation. J Foot Ankle Surg, 2014, 53(5): 609-614.
4.	秦泗河. 基于宏观思维理念对足踝外科发展方向的思考. 中华外科杂志, 2013, 51(10): 872-874.
5.	秦泗河, 焦绍峰, 葛建中. 脊椎裂致足踝畸形的分类与外科治疗策略. 中国矫形外科杂志, 2012, 20(3): 284-288.
6.	臧建成, 秦泗河. 从 Wolff 定律和 Ilizarov 张力-应力法则到骨科自然重建理念. 中国骨伤, 2013, 26(4): 287-290.
7.	Zambito A, Dall’oca C, Polo A, et al. Spina bifida occulta. Foot deformities, enuresis and vertebral cleft: clinical picture and neurophysiological assessment. Eur J Phys Rehabil Med, 2008, 44(4): 437-440.
8.	Fletcher JM, Copeland K, Frederick JA, et al. Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity. J Neurosurg, 2005, 102(3 Suppl): 268-279.
9.	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.
10.	臧建成, 秦泗河, 焦绍锋, 等. 骨外固定技术治疗脊柱裂后遗足踝畸形. 中国矫形外科杂志, 2017, 25(4): 308-311.
11.	Kawoosa AA, Baba MA, Wani IH, et al. Ankle arthrodesis using the Ilizarov technique in difficult situations-a prospective study with mid-to long-term follow up. Ortop Traumatol Rehabil, 2015, 17(2): 147-153.
12.	Strotman PK, Reif TJ, Pinzur MS. Charcot arthropathy of the foot and ankle. Foot Ankle Int, 2016, 37(11): 1255-1263.
13.	Cousins S. Accounting for polio survivors in the post-polio world. Lancet, 2017, 389(10078): 1503-1504.
14.	Booth S, Ballal M, Pillai A. Complex ankle arthrodesis with step-cut osteotomy in Charcot arthropathy with bone loss. Foot Ankle Surg, 2017, 23(1): e5-e7.
15.	焦绍锋, 秦泗河, 任龙喜, 等. 组合性手术治疗脊柱裂后遗踝足畸形. 中国骨伤, 2012, 25(3): 237-240.
16.	Wang XJ, Chang F, Su Y, et al. Ilizarov technique and limited surgical methods for correction of post-traumatic talipes equinovarus in children. ANZ J Surg, 2017, 87(10): 815-819.
17.	El-Sayed M. Ilizarov external fixation for management of severe relapsed clubfeet in older children. Foot Ankle Surg, 2013, 19(3): 177-181.
18.	秦泗河, 郭保逢, 郑学建, 等. 国产骨外固定器治疗四肢残缺畸形 7 289 例应用报告. 中华外科杂志, 2017, 55(9): 678-683.
19.	Abe I, Ishiya K, Oshimoto T, et al. Ankle-foot orthosis using elastomer-embedded flexible joint. Conf Proc IEEE Eng Med Biol Soc, 2017, 2017: 4499-4502.

1. 秦泗河, 葛建忠, 郭保逢. 脊椎裂后遗足踝畸形的临床分析. 中华外科杂志, 2010, 48(12): 900-903.
2. Latt LD, Smith KE, Dupont KM. Revision tibiotalocalcaneal arthrodesis with a pseudoelastic intramedullary nail. Foot Ankle Spec, 2017, 10(1): 75-81.
3. Crawford B, Watson JT, Jackman J, et al. End-stage hindfoot arthrosis: outcomes of tibiocalcaneal fusion using internal and Ilizarov fixation. J Foot Ankle Surg, 2014, 53(5): 609-614.
4. 秦泗河. 基于宏观思维理念对足踝外科发展方向的思考. 中华外科杂志, 2013, 51(10): 872-874.
5. 秦泗河, 焦绍峰, 葛建中. 脊椎裂致足踝畸形的分类与外科治疗策略. 中国矫形外科杂志, 2012, 20(3): 284-288.
6. 臧建成, 秦泗河. 从 Wolff 定律和 Ilizarov 张力-应力法则到骨科自然重建理念. 中国骨伤, 2013, 26(4): 287-290.
7. Zambito A, Dall’oca C, Polo A, et al. Spina bifida occulta. Foot deformities, enuresis and vertebral cleft: clinical picture and neurophysiological assessment. Eur J Phys Rehabil Med, 2008, 44(4): 437-440.
8. Fletcher JM, Copeland K, Frederick JA, et al. Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity. J Neurosurg, 2005, 102(3 Suppl): 268-279.
9. 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.
10. 臧建成, 秦泗河, 焦绍锋, 等. 骨外固定技术治疗脊柱裂后遗足踝畸形. 中国矫形外科杂志, 2017, 25(4): 308-311.
11. Kawoosa AA, Baba MA, Wani IH, et al. Ankle arthrodesis using the Ilizarov technique in difficult situations-a prospective study with mid-to long-term follow up. Ortop Traumatol Rehabil, 2015, 17(2): 147-153.
12. Strotman PK, Reif TJ, Pinzur MS. Charcot arthropathy of the foot and ankle. Foot Ankle Int, 2016, 37(11): 1255-1263.
13. Cousins S. Accounting for polio survivors in the post-polio world. Lancet, 2017, 389(10078): 1503-1504.
14. Booth S, Ballal M, Pillai A. Complex ankle arthrodesis with step-cut osteotomy in Charcot arthropathy with bone loss. Foot Ankle Surg, 2017, 23(1): e5-e7.
15. 焦绍锋, 秦泗河, 任龙喜, 等. 组合性手术治疗脊柱裂后遗踝足畸形. 中国骨伤, 2012, 25(3): 237-240.
16. Wang XJ, Chang F, Su Y, et al. Ilizarov technique and limited surgical methods for correction of post-traumatic talipes equinovarus in children. ANZ J Surg, 2017, 87(10): 815-819.
17. El-Sayed M. Ilizarov external fixation for management of severe relapsed clubfeet in older children. Foot Ankle Surg, 2013, 19(3): 177-181.
18. 秦泗河, 郭保逢, 郑学建, 等. 国产骨外固定器治疗四肢残缺畸形 7 289 例应用报告. 中华外科杂志, 2017, 55(9): 678-683.
19. Abe I, Ishiya K, Oshimoto T, et al. Ankle-foot orthosis using elastomer-embedded flexible joint. Conf Proc IEEE Eng Med Biol Soc, 2017, 2017: 4499-4502.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult

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