70年来の麻痺性尖足に対し，subtotal talectomy（距骨体部切除術）による矯正を行った1例

Ankle Arthroplasty by Excision of the Talar Body Subtotal Talectomy for Paralytic Talipes Equinus Deformity for 70 Years : Case Report

　抄録：70年来の脊髄性小児麻痺による単下肢麻痺による尖足変形に対して距骨体部切除術（subtotal talectomy）を施行し良好な結果を得たので報告する．距骨体部切除術は，関節固定を目的とせず，単に距骨体部を切除するという極めて容易な方法であり，内反尖足変形はこの手術による矯正力が大きく，多くの場合アキレス腱の延長は不要で再発はない．予後では，距腿関節を失いけい骨と踵骨がつくる関節は内外反の制御されたヒンジ運動となるが，距骨頭部を残すことにより，痙性，麻痺性を問わず疼痛のない安定した足関節を得ることができる．そして，この手術の長所は早期歩行が可能なことである．

　A 75-year-old woman was referred to our clinic because of paralytic talipes equinus deformity of the right foot. She had been diagnosed with spinal infantile palsy at 3 years of age. A plain X-p radiograph showed a tibio-talar angle of 196 degrees, and a tibio-calcaneal angle of 148 degrees in the sagittal plane. The patient that strongly by desired that the paralytic talipes equinus deformity be corrected, and subtotal talectomy was performed.

　After the operation, the tibio-talar angle had decreased to 90 degrees, and the tibio-calcaneal angle had decreased to 55 degrees. The postoperative course was uneventful. As of the 5-month follow-up examination, the patient is asymptomatic and satisfied with the results. This operation is technically simple. A stable ankle joint can be achieved according to acquiring of the conformity of the tibial surface over the calcaneal joint and tibial-talar head junction. The average limb shortening observed in all patients was approximately one inch, and the shortening was not a problem clinically. A patient with spinal infantile palsy and paralytic talipes equinus deformity was successfully treated by subtotal talectomy.