Lampasi M, Bettuzzi C, Palmonari M, Donzelli O
Department of Pediatric Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
J Bone Joint Surg Br. 2010 Feb;92(2):277-83. doi: 10.1302/0301-620X.92B2.22504.
A total of 38 relapsed congenital clubfeet (16 stiff, 22 partially correctable) underwent revision of soft-tissue surgery, with or without a bony procedure, and transfer of the tendon of tibialis anterior at a mean age of 4.8 years (2.0 to 10.1). The tendon was transferred to the third cuneiform in five cases, to the base of the third metatarsal in ten and to the base of the fourth in 23. The patients were reviewed at a mean follow-up of 24.8 years (10.8 to 35.6). A total of 11 feet were regarded as failures (one a tendon failure, five with a subtalar fusion due to over-correction, and five with a triple arthrodesis due to under-correction or relapse). In the remaining feet the clinical outcome was excellent or good in 20 and fair or poor in seven. The mean Laaveg-Ponseti score was 81.6 of 100 points (52 to 92). Stiffness was mild in four feet and moderate or severe in 23. Comparison between the post-operative and follow-up radiographs showed statistically significant variations of the talo-first metatarsal angle towards abduction. Variations of the talocalcaneal angles and of the overlap ratio were not significant. Extensive surgery for relapsed clubfoot has a high rate of poor long-term results. The addition of transfer of the tendon of tibialis anterior can restore balance and may provide some improvement of forefoot adduction. However, it has a considerable complication rate, including failure of transfer, over-correction, and weakening of dorsiflexion. The procedure should be reserved for those limited cases in which muscle imbalance is a causative or contributing factor.
共有38例复发性先天性马蹄内翻足（16例僵硬型，22例部分可矫正型）接受了软组织手术翻修，部分患者还进行了骨性手术，并平均在4.8岁（2.0至10.1岁）时进行了胫前肌腱转移。5例患者的肌腱转移至第三楔骨，10例转移至第三跖骨基底，23例转移至第四跖骨基底。患者平均随访24.8年（10.8至35.6年）。共有11只脚被视为治疗失败（1例肌腱转移失败，5例因过度矫正导致距下关节融合，5例因矫正不足或复发导致三关节融合）。其余患足中，20例临床结果为优或良，7例为中或差。平均Laaveg-Ponseti评分为81.6分（满分100分，52至92分）。4只脚僵硬程度为轻度，23只为中度或重度。术后与随访X线片对比显示，距骨-第一跖骨角在外展方向上有统计学意义的变化。距跟角和重叠率的变化无统计学意义。复发性马蹄内翻足的广泛手术长期效果不佳的发生率较高。增加胫前肌腱转移可恢复平衡，并可能改善前足内收情况。然而，其并发症发生率较高，包括肌腱转移失败、过度矫正和背屈减弱。该手术应仅用于肌肉失衡是病因或促成因素的有限病例。
