Carda Stefano, Bertoni Michele, Zerbinati Paolo, Rossini Mauro, Magoni Luciana, Molteni Franco
Villa Beretta Rehabilitation Centre, Ospedale Valduce, Costamasnaga, LC, Italy,
Am J Phys Med Rehabil. 2009 Apr;88(4):292-301. doi: 10.1097/PHM.0b013e318198b593.
In patients with hemiplegic stroke, equinovarus foot is one of the most frequent deformities. Outcome evidence for surgical correction of equinovarus foot is scarce, and results are usually assessed only clinically. Moreover, concerns about possible loss of function after elongation of the plantar flexor muscles are still at issue. The objective of this study was to verify if surgical correction of equinovarus foot can improve gait speed and function.
We used a retrospective, nonrandomized design. One hundred seventy-seven chronic hemiplegic patients who underwent surgical correction of equinovarus foot were evaluated before and 1 yr after surgery. Outcome measures were walking handicap score, temporal-spatial parameters, gait kinematics and kinetics, and paretic propulsion.
After surgery, walking handicap and temporal-spatial parameters significantly improved, as did ankle kinematic data and gait kinetic data. Patients' gait at follow-up was faster, with a more normal base of support and with better foot advancement. Paretic propulsion increased significantly after surgery, even if ankle power at push-off was reduced. We also observed a low complication rate.
Surgical correction of equinovarus foot deformity in patients with stroke is a safe and effective procedure. Even if the power generation at the ankle decreased, overall gait function and parameters improved after surgery.
在偏瘫性脑卒中患者中，马蹄内翻足是最常见的畸形之一。关于马蹄内翻足手术矫正的疗效证据稀缺，且结果通常仅通过临床评估。此外，对于跖屈肌延长后可能出现的功能丧失问题仍存在争议。本研究的目的是验证马蹄内翻足的手术矫正是否能提高步态速度和功能。
我们采用回顾性、非随机设计。对177例行马蹄内翻足手术矫正的慢性偏瘫患者在术前及术后1年进行评估。结果指标包括步行障碍评分、时空参数、步态运动学和动力学以及患侧推进力。
术后，步行障碍和时空参数显著改善，踝关节运动学数据和步态动力学数据也有所改善。随访时患者的步态更快，支撑面更正常，足部推进更好。术后患侧推进力显著增加，即使蹬离时踝关节力量有所下降。我们还观察到并发症发生率较低。
对脑卒中患者的马蹄内翻足畸形进行手术矫正是一种安全有效的手术。即使踝关节的发力减少，但术后总体步态功能和参数仍有所改善。
