Dobbs Matthew B, Gordon J Eric, Walton Timothy, Schoenecker Perry L
Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110.
J Pediatr Orthop. 2004 Jul-Aug;24(4):353-7. doi: 10.1097/00004694-200407000-00002.
Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by application of well-molded long-leg plaster casts and a percutaneous tendoachilles tenotomy to correct residual equinus contracture. Medical complications occurring as a result of this technique have not to our knowledge been reported. The authors retrospectively reviewed 134 consecutive infants with 219 idiopathic clubfeet treated with the Ponseti method. A percutaneous tendoachilles tenotomy was performed on 200 clubfeet (91%) at a mean age of 16 weeks (range, 6-77 weeks) when less than 10 degress of ankle dorsiflexion was present after casting. A total of 4 patients had serious bleeding complications following the percutaneous tendoachillis tenotomy--3 due to presumed injury to the peroneal artery and 1 due to injury to the lesser saphenous vein. The authors detail the technique of performing a percutaneous tendoachilles tenotomy and offer guidelines that may help others avoid this same complication.
庞塞蒂证明,通过适当的手法技术,随后应用塑形良好的长腿石膏管型以及经皮跟腱切断术来纠正残留的马蹄足挛缩,大多数婴儿的马蹄内翻足可以得到矫正。据我们所知,尚未有因该技术导致的医学并发症的报道。作者回顾性分析了134例连续的婴儿,他们共患有219例特发性马蹄内翻足,均采用庞塞蒂方法进行治疗。当石膏固定后踝关节背屈小于10度时,对200例马蹄内翻足(91%)在平均16周龄(范围6 - 77周)时进行了经皮跟腱切断术。共有4例患者在经皮跟腱切断术后出现严重出血并发症——3例是由于腓动脉可能受损,1例是由于小隐静脉受损。作者详细介绍了经皮跟腱切断术的操作技术,并提供了一些指导原则,可能有助于其他人避免同样的并发症。