Kuo Ken N, Smith Peter A
National Taiwan University Hospital, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, 35053, Taiwan, ROC.
Clin Orthop Relat Res. 2009 May;467(5):1326-33. doi: 10.1007/s11999-008-0664-y. Epub 2008 Dec 17.
There are many possible pitfalls of clubfoot releases and it is important to recognize the problems and provide proper timely treatment. Late residual deformity following clubfoot releases include: dynamic or stiff supination and forefoot adduction deformities, intoeing gait, overcorrection, rotatory dorsal subluxation of the navicular, vascular insult to the talus with collapse, and dorsal bunion. We reviewed 134 clubfeet in 95 children who had primary clubfoot releases between 1988 and 1991. In general, the patients who underwent surgery before 6 months of age had poorer results compared with older children. Twenty-one feet (15.7%) underwent additional procedures. The most common additional procedure was split anterior tibial tendon transfer. Not all patients with residual deformities underwent additional procedures. In treating recurrent and residual deformity following a clubfoot surgery, it is most important to keep function in mind. From this series of patients treated with comprehensive clubfoot release, we have identified the most common residual deformities encountered after the initial release and effective surgical treatment when necessary.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
马蹄足松解存在许多潜在风险，认识到这些问题并及时给予恰当治疗很重要。马蹄足松解术后的晚期残留畸形包括：动态或僵硬的内旋和前足内收畸形、内八字步态、过度矫正、舟骨旋转性背侧半脱位、距骨血管损伤伴塌陷以及拇囊炎。我们回顾了1988年至1991年间接受初次马蹄足松解的95例儿童的134只马蹄足。总体而言，6个月龄前接受手术的患者与年龄较大的儿童相比，效果较差。21只足（15.7%）接受了额外手术。最常见的额外手术是胫前肌腱劈开转移术。并非所有残留畸形患者都接受了额外手术。在治疗马蹄足手术后的复发性和残留畸形时，最重要的是牢记功能。从这一系列接受全面马蹄足松解治疗的患者中，我们确定了初次松解后最常见的残留畸形以及必要时有效的手术治疗方法。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
