Park S-S, Kim S W, Jung B-S, Lee H S, Kim J S
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwongil, Songpa-gu, Seoul 138-736, Korea.
J Bone Joint Surg Br. 2009 Nov;91(11):1526-30. doi: 10.1302/0301-620X.91B11.22327.
We reviewed the results of a selective à la carte soft-tissue release operation for recurrent or residual deformity after initial conservative treatment for idiopathic clubfoot by the Ponseti method. Recurrent or residual deformity occurred in 13 (19 feet) of 33 patients (48 feet; 40%). The mean age at surgery was 2.3 years (1.3 to 4) and the mean follow-up was 3.6 years (2 to 5.3). The mean Pirani score had improved from 2.8 to 1.1 points, and the clinical and radiological results were satisfactory in all patients. However, six of the 13 patients (9 of 19 feet) had required further surgery in the form of tibial derotation osteotomy, split anterior tibialis tendon transfer, split posterior tibialis transfer or a combination of these for recurrent deformity. We concluded that selective soft-tissue release can provide satisfactory early results after failure of initial treatment of clubfoot by the Ponseti method, but long-term follow-up to skeletal maturity will be necessary.
我们回顾了在采用庞塞蒂方法对特发性马蹄内翻足进行初始保守治疗后，针对复发性或残留畸形进行的选择性单点软组织松解手术的结果。33例患者（48足）中有13例（19足）出现复发性或残留畸形（40%）。手术时的平均年龄为2.3岁（1.3至4岁），平均随访时间为3.6年（2至5.3年）。平均皮拉尼评分从2.8分提高到了1.1分，所有患者的临床和放射学结果均令人满意。然而，13例患者中有6例（19足中的9足）因复发性畸形需要进一步手术，手术方式为胫骨旋转截骨术、胫前肌腱劈开转移术、胫后肌腱劈开转移术或这些手术的联合应用。我们得出结论，在庞塞蒂方法对马蹄内翻足的初始治疗失败后，选择性软组织松解可提供令人满意的早期结果，但有必要对骨骼成熟进行长期随访。
