Roposch A, Scher D M, Mubarak S, Kotz R
Universitätsklinik für Orthopädie Wien, Vienna.
Z Orthop Ihre Grenzgeb. 2003 Jan-Feb;141(1):54-8. doi: 10.1055/s-2003-37295.
There are different approaches to treat foot deformities in Duchenne muscular dystrophy. Some authors recommend conservative, others only surgical means. The purpose of this study was to compare the outcome of both non-surgical and surgical treatment.
The records of 91 boys with DMD were retrospectively evaluated. The three treatment groups studied included group 1, those who had no surgery, group 2, those who had surgery to correct foot position, and group 3, those who had surgery to maintain ambulation and correct foot position.
Although conservative treatment of the feet in group 1 was carried out, severe equinovarus deformities developed. Surgery for the foot deformity including posterior tibial transfer was successful in 94 % at mean 8.5 years post-operative follow-up. The mean age of cessation of ambulation for those who had surgery to maintain ambulation was 11.2 years versus 10.3 years of those who did not have surgery (p < 0.05).
In patients with DMD, lower extremity surgery including posterior tibial tendon transfer can successfully correct and maintain foot position, as well as prolong ambulation. Early surgical treatment is required since conservative means can not prevent progression to severe equinovarus deformities.
治疗杜氏肌营养不良症足部畸形有不同的方法。一些作者推荐保守治疗，另一些则仅推荐手术治疗。本研究的目的是比较非手术和手术治疗的效果。
回顾性评估91例杜氏肌营养不良症男孩的病历。所研究的三个治疗组包括：第1组，未接受手术的患儿；第2组，接受手术矫正足部位置的患儿；第3组，接受手术以维持行走能力并矫正足部位置的患儿。
尽管对第1组患儿的足部进行了保守治疗，但仍出现了严重的马蹄内翻畸形。在术后平均8.5年的随访中，包括胫后肌腱转移术在内的足部畸形手术成功率为94%。接受手术以维持行走能力的患儿停止行走的平均年龄为11.2岁，而未接受手术的患儿为10.3岁（p<0.05）。
在杜氏肌营养不良症患者中，包括胫后肌腱转移术在内的下肢手术能够成功矫正并维持足部位置，还能延长行走时间。由于保守治疗无法防止发展为严重的马蹄内翻畸形，因此需要早期手术治疗。
