Grzegorzewski Andrzej, Borowski Andrzej, Pruszczyński Błazej, Wranicz Anna, Domzalski Marcin, Synder Marek
Klinika Ortopedii i Ortopedii Dzieciecej, Uniwersytet Medyczny w Lodzi.
Chir Narzadow Ruchu Ortop Pol. 2007 Mar-Apr;72(2):117-20.
Equinovarus deformity of the foot is a result of the muscles imbalance in which inventors of the foot, mostly posterior and anterior tibialis muscle, overpower evertors. In children with cerebral palsy untreated spastic equinovarus deformity may cause severe fixed foot deformity and painful callosities under metatarsal heads and on the lateral side of the foot. The gait pattern becomes less effective and needs more energy. The study group consisted of 154 children with cerebral palsy treated in our Clinic by the multilevel soft tissue surgery. For foot problems 136 children needed surgical intervention. In 19 ambulatory patients, with hemiplegia or diplegia, split tibialis posterior tendon transfer together with tendo Achilles lengthening and plantar aponeurectomy were performed. The study was based on clinical examination, parents' questionnaire, radiology and gait analysis at least one year after surgery. The mean follow up was 4.6 years. The functional improvement was observed in 17 (89%) children with tendon transfer. At the last follow up those patients were brace free, with plantigrade foot while walking (without DAFO orthesis) and normal shoes were used. All painful callosities disappeared. On a standing AP X-ray adequate correction of the hindfoot-forefoot relation was achieved in 14 (74%) cases. Persistent equinovarus deformity over 10 degrees was observed in 2 cases. Those patients underwent additional bone surgery. With a properly planned approach the split tibialis posterior tendon transfer can bring good clinical and functional results in CP children with equinovarus deformation. We recommend this procedure in early stage of the deformity what can eliminate more harmful triple arthrodesis in severe deformities.
马蹄内翻足畸形是足部肌肉失衡的结果，足部内翻肌，主要是胫后肌和胫前肌，力量超过外翻肌。在未经治疗的痉挛性马蹄内翻足畸形的脑瘫患儿中，可能会导致严重的固定性足部畸形以及跖骨头下方和足外侧出现疼痛性胼胝。步态模式变得效率低下且需要更多能量。研究组由154例在我们诊所接受多级软组织手术治疗的脑瘫患儿组成。对于足部问题，136名儿童需要手术干预。在19名门诊患者中，有偏瘫或双瘫，进行了胫后肌腱劈开转移术，同时进行跟腱延长术和跖腱膜切除术。该研究基于术后至少一年的临床检查、家长问卷、放射学和步态分析。平均随访时间为4.6年。在17名（89%）接受肌腱转移的儿童中观察到功能改善。在最后一次随访时，这些患者无需使用支具，行走时足部呈平足（无需使用动态踝足矫形器）且穿着正常鞋子。所有疼痛性胼胝均消失。在站立位前后位X线片上，14例（74%）病例实现了后足-前足关系的充分矫正。2例患者观察到持续性马蹄内翻畸形超过10度。这些患者接受了额外的骨手术。通过适当规划的方法，胫后肌腱劈开转移术可为患有马蹄内翻畸形的脑瘫儿童带来良好的临床和功能结果。我们建议在畸形早期采用该手术，这可以避免在严重畸形中进行更具伤害性的三关节融合术。
