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Jingdong book

儿童足踝畸形矫治原则和技术

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儿童足踝畸形矫治原则和技术

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本书是一部讲述小儿足踝畸形的诊断和治疗的专著。儿童足踝畸形在小儿骨科领域占有重要的地位,因为小儿足踝畸形的发生率在小儿四肢畸形中非常高,而且如果没有及时正确的治愈,造成的功能障碍将影响孩子的一生。本书围绕小儿足踝的各种畸形,从足踝部的正常解剖,生物力学和生理等方面进行阐述,然后介绍各种足踝畸形的解剖,病理生理,生物力学和发病机制,以期让读者更容易理解各种足踝畸形的发病机制和病理生理及解剖异常,引导读者如何判断和评估畸形,并能有针对性的提出治疗方案。本书列举的各种足踝畸形均是小儿骨科领域中的常见病,多发病及绝大部分的疑难杂症。
Catalogue

第1 章绪言
撰写本书的目的
怎样使用本书
第2 章基本原则
基本原则1 治疗技术不断改进,但原则不变
基本原则2 诊断和治疗儿童足踝畸形的前提条件是掌握正常儿童足踝解剖
基本原则3 儿童正常足踝的形态不同于成人
基本原则4 必须掌握儿童正常生长发育中足踝外形的解剖改变及其自然转归
基本原则5 “足踝不是一个关节!”不管是何种类型的足踝畸形,至少存在两个节
段以上的相对旋转的移位畸形,“就像拧绞足部一样”
基本原则6 对于距下关节的位置和活动的表达不同于文献中常见的术语
基本原则7 掌握足踝的生物力学,特别是距下关节复合体的力线是正确评估和治
疗儿童足踝畸形的前提
基本原则8 正常足踝的形状是由足踝部骨骼的形态和关系、韧带的强度和弹性相
互作用决定的。足踝的肌肉起到了保持平衡,调节足踝适应各种地形,
保护韧带和推动躯体前行的作用
基本原则9 距下关节的默认位置为外翻位
基本原则10 通常认为后足的外翻畸形是一个连续体的表现
基本原则11 高弓是中空的、弓形的足,表现为前足相对于后足产生跖屈畸形。跖
屈可能沿着足的内侧柱,也可能是通过整个中足。距下关节位置可能
是内翻、外翻或中立位。踝关节可能是马蹄位、中立或者背伸位。也
有可能是上述各种畸形结合
基本原则12 足踝畸形可能原发,也可能继发于神经肌肉系统疾病。鉴别诊断很重要
基本原则13 正确使用和理解各种术语
基本原则14 不要只注重足踝的治疗,而忘记了足踝的上面是儿童的躯体
第3 章评估原则
评估原则1 治疗前必须进行儿童足踝的详尽的临床和放射检查

Introduction

不知不觉,我在小儿骨科工作已经21 年。在这21 年中,从一个懵懂的住院医生逐渐成长为一个小儿骨科的专科医生。期间除了完成小儿骨科繁重的临床医疗任务以外,逐步专注于儿童的足踝矫治。2002、2003 年,我赴法国蒙彼利埃大学医学院担任小儿骨科住院医师,师从Dimeglio 教授,专门进修儿童马蹄足矫治。期间我学到了马蹄足的手术矫正方法,更学到了小儿肢体畸形的微创甚至无创治疗的理念。2008 年,我在西雅图儿童医院骨科访学,师从Mosca 教授,全方面学习儿童足踝畸形的矫治。期间不仅系统学习了Ponseti 系列石膏矫形法,掌握了微创矫治足踝畸形的理念,更体会到了国外小儿骨科专科医生的为人处事方法和哲学观。Mosca 教授不仅医术高明、手术技艺高超,更让人钦佩的是其高尚的医德。Mosca 教授是国际儿童足踝畸形矫治的权威,他热衷于传播和发扬自己的专业理论、技术和经验,他是AAOS 国际讲师团成员之一,平均每年有10 周左右受邀到世界各地讲课和演示手术。此外他协助Staheli 教授创办了GLOBAL-HELP 基金会,免费为亚非拉经济欠发达地区培训小儿骨科医生,推广Ponseti 治疗法及其他小儿骨科专科的理论和技术,为该地区贫困患儿的诊治提供帮助。我回国后在工作中不仅引入国外的先进技术和理念,更努力践行其职业操守。
Mosca 教授出版的《儿童足踝畸形矫治原则和技术》是一本儿童足踝方面的专著。纵观国际小儿骨科界,此类专著凤毛麟角。而国内小儿骨科近年来得到了长足的发展,但是儿童足踝方面仍然有很多不足甚至空白。当拜读完老师的专著后,我深深地感到,除了将学到的技术应用于国内的儿童病患以外,更有义务发挥自己的优势,将这部专著翻译成中文出版发行,推广恩师的专业理念和技术,使之得到传承和发展,从而使更多的中国患儿受益。不可避免,因为东西方文化差异,以及国内外小儿骨科发展的不平衡,一些英文的专有名词无法找到对应的中文翻译,在此过程中查阅了大量的中文专著和专业名词,希望可以做到一一对应,以减少阅读时的误解。如有翻译不到之处,还请谅解并多提宝贵意见。为了及时准确地完成编译工作,特邀请了4 位长期在国内足踝矫形骨科领域工作的专家和他们的同事共同翻译和审校。他们都付出了大量的心血,在此一并表示感谢!谢 丰2016 年1 月
英文版序言我认识Vincent Mosca 医生已经超过25 年了,他是我的同事、朋友,是一个我钦佩的人。在过去的25 年中,我看着他从一个天才但缺乏经验的小儿骨科医生逐步历练成为在儿童足踝畸形治疗方面的国际权威。我把这种发展经历不仅归因于Mosca 医生作为外科医生、创新者、教师所具备的天才的能力,而且也归因于他对儿童足踝这个相对广阔而被忽视的领域浓厚的兴趣。这本《儿童足踝畸形矫治原则和技术》是Mosca 医生对儿童足踝研究的高度总结,是他临床研究、创新和经验的积累,是他几十年讲课、教学及数百次国内和国际会议受邀讲学的精髓。他数次得到华盛顿大学骨科教学的表彰,经常作为国际专家组的成员。除了发表他的研究论文以外,他还是很多小儿骨科专著中儿童足踝章节的作者。本书中Mosca 医生强调了读者应该理解和掌握儿童足踝的复杂性,引导读者由简入繁地制订诊疗计划。本书给读者提供了理解和评估临床问题的工具,以及成功治疗足踝疾病的详细信息,同时也介绍了足踝常见并发症的处理。本书中有很多彩色的插图、注释和照片,读者阅读时可一目了然。这些精美的照片由Mosca 医生亲自拍摄,他在手术室和门诊付出了很大的辛劳。可以想象他在手术时需要更
换数百双手套才能拍出这么精美的俯视位照片。有了这些照片就可以免去画家的素描,且可以使读者看到清晰的手术中的解剖情况。当一个天才的思维、丰富的经验、不断创新的理念、注重细节的特质和善于教学的能力汇聚在一起时,这本书应运而生。在阅读前,我以为这是一本经典的专著,而在阅读后,我发现它不仅经典,而且可以在未来不断引导我们加深理解,从而更好地处理儿童足踝畸形。Lynn T. Staheli, MD
1 英文版前言“技术不断发展,但原则不变”。足踝,特别是儿童足踝是一个复杂的解剖学器官,包含很多骨骼、关节、肌肉和肌腱等,它们共同配合,提供了一个稳定而不僵硬、平坦的足,能够适应多变的地形,并推动身体前行。足踝会有很多先天性、发育性或获得性的畸形,这些畸形影响了足踝的正常功能。这些畸形在自然病史、严重程度、柔软性、僵硬度、发病年龄、治疗年龄和发展速度上会有很多的差异。因此,如果想获得最佳的治疗结果,必须根据临床诊疗原则进行处理。传统的治疗儿童足踝畸形的方法是以治疗技术为基础的。常常可以找到根据疾病名称来命名的手术方法的操作手册。然而很多医源性的足踝畸形和罕见的、特发性的足踝畸形却没有相应的治疗手册。在这种情况下,如果没有对足踝畸形有充分的理解,就无法决定诊治方案。另外,技术不断进步,人类不断创新,所以诊治技术在不断改进。如果没有对足踝畸形的充分理解,就无法评估和比较新旧技术。很明显,对于处理多变的、少见的儿童足踝畸形必须遵循其原则,而以原则为基础的治疗同样依赖于以原则为基础的评估。原则是一种被普遍接受的真理,并可以用来进行推导。撰写本书的目的是介绍儿童足踝畸形的矫治原则,而这个原则来源于一位从事儿童足踝畸形诊治和研究30 年的小儿骨科医生,
笔者将获得的经验发展、组织和总结,然后将其应用于儿童足踝畸形的诊治。最后,笔者将自己进行的软组织和骨骼手术技术进行详细描述,不少内容很难在其他书中找到。本书并不是一本教科书,而是临床实用的便于掌握的操作手册。书中重点提到了手术和非手术治疗的指征,配合照片详述了手术技巧,讨论了各种治疗的缺点和并发症的处理。怎样使用本书:在第1 章绪言以后,第2~4 章描述了治疗儿童足踝畸形所需的基础、评估和处理原则。在第5 和第6 章中,详细介绍了各种足踝畸形,包括定义、各个节段的畸形、影像学表现、自然病史、非手术治疗、手术指征和手术治疗方法等。绝大多数足踝畸形的矫正需要同时或连续进行至少一次软组织和(或)骨骼的手术。为了避免重复和多余,在第7 和第8 章中详细介绍手术操作过程。第5 和第6 章中提及的每一种畸形的手术治疗方法都在最后两章中有详细描述。在手术治疗的章节中还介绍了各种手术方法的联合应用,并对一些特殊病情的治疗进行了改良。本书以一位骨科医生在此领域的知识和经验为基础,其中介绍的原则为笔者原创。手术技术有笔者原创的,也有其他作者原创的,但经过笔者引用、改良。本书最后的参考文献可以让有兴趣的读者找到原创的文献。最后我希望本书可以为读者提供儿童足踝畸形的诊治思路和方法。Vincent S. Mosca, MD

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