Parada Stephen A, Baird Glen O, Auffant Roberto A, Tompkins Bryan J, Caskey Paul M
Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
J Pediatr Orthop. 2009 Dec;29(8):916-9. doi: 10.1097/BPO.0b013e3181c18ab5.
Most patients with idiopathic clubfeet require a percutaneous tendoachilles tenotomy to correct residual equinus deformity. This procedure is typically performed with the child awake in an outpatient setting. Percutaneous tendoachilles tenotomy under general anesthesia offers the potential advantages of better pain control, the ability to perform the procedure in a more controlled manner, and the possibility of lessening the pain response of the infant. Potential disadvantages include concerns regarding the safety of general anesthesia in infants. The purpose of this study is to review the safety of this procedure performed in the operating room under general anesthesia.
A retrospective review was carried out of patients with idiopathic clubfoot less than 1 year of age who underwent percutaneous tendoachilles tenotomy under general anesthesia from 2000 to 2008. Patient medical records were reviewed for gestational age, age at surgery, risk factors for anesthesia, and surgical/anesthesia-related complications. To be discharged on the day of surgery, patients met the accepted criteria. Children at risk for apnea were considered for overnight observation using established criteria of postconception age under 44 weeks, premature birth, pulmonary comorbidities, and history of an apneic event.
One hundred and thirty-seven patients underwent a total of 182 tenotomies under general anesthesia. Ninety-two tenotomies were unilateral, 45 were bilateral. The average postconception age at time of surgery was 53.9 weeks (range, 41 to 90 wk, SD 9.8 wk). Eighty-nine patients were under 3 months of age. Twenty-one patients (15.3%) met the criteria for the observation for postoperative monitoring for apnea because of postconception age under 44 weeks or gestational age under 37 weeks. Three patients were admitted overnight because of a maternal history of drug abuse. No patients had earlier apneic events or were American Society of Anesthesiologists Class III for comorbidities. No patient showed apnea or anesthesia-related complications.
Percutaneous tendoachilles tenotomy under general anesthesia can be safely performed in infants with clubfeet. No complications related to anesthesia were identified in this group and nearly all patients were discharged on the day of surgery.
Prognostic level 3.
大多数特发性马蹄内翻足患者需要进行经皮跟腱切断术来纠正残留的马蹄畸形。该手术通常在门诊让患儿清醒状态下进行。全身麻醉下的经皮跟腱切断术具有潜在优势，如更好的疼痛控制、能以更可控的方式进行手术以及有可能减轻婴儿的疼痛反应。潜在的缺点包括对婴儿全身麻醉安全性的担忧。本研究的目的是回顾在手术室全身麻醉下进行该手术的安全性。
对2000年至2008年期间在全身麻醉下接受经皮跟腱切断术的1岁以下特发性马蹄内翻足患者进行回顾性研究。查阅患者病历以了解胎龄、手术年龄、麻醉风险因素以及手术/麻醉相关并发症。为在手术当天出院，患者需符合既定标准。对于有呼吸暂停风险的儿童，根据胎龄小于44周、早产、肺部合并症以及呼吸暂停事件史等既定标准考虑进行过夜观察。
137例患者在全身麻醉下共进行了182次跟腱切断术。92次为单侧切断，45次为双侧切断。手术时的平均胎龄为53.9周（范围41至90周，标准差9.8周）。89例患者年龄小于3个月。21例患者（15.3%）因胎龄小于44周或孕周小于37周符合术后呼吸暂停监测观察标准。3例患者因母亲有药物滥用史而留院过夜。没有患者有早期呼吸暂停事件或因合并症属于美国麻醉医师协会Ⅲ级。没有患者出现呼吸暂停或麻醉相关并发症。
全身麻醉下的经皮跟腱切断术可在患有马蹄内翻足的婴儿中安全进行。该组未发现与麻醉相关的并发症，几乎所有患者在手术当天出院。
预后水平3。
