Doğan Ahmet, Uzümcügil Onat, Yalçinkaya Merter, Zorer Gazi
Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):491-6. doi: 10.3944/AOTT.2009.491.
We evaluated the effect of abductor hallucis (AH) tendon release on residual adductus deformity in the surgical treatment of congenital clubfoot.
The study included 35 patients with congenital clubfoot. Thirteen patients (group 1, 21 feet) underwent classical complete subtalar release, while 22 patients (group 2, 31 feet) underwent the same treatment combined with AH muscle release by stripping it plantarward and transecting it distally. The mean age was 19.4 months (range 13 to 39 months) in group 1, and 13.5 months (range 11 to 25 months) in group 2. The mean follow-up period was 55.5 months (range 36 to 77 months) in group 1, and 24.7 months (range 10 to 37 months) in group 2. Radiographic assessments were made on preoperative, early postoperative, and final radiographs for the anteroposterior talo-first metatarsal angle and calcaneocuboid relationship, and for the anteroposterior naviculometatarsal angle and talonavicular relationship on final radiographs.
Both groups showed significant improvement in the anteroposterior talo-first metatarsal angle in the early postoperative period (p<0.001); however, early and late postoperative talo-first metatarsal angle did not differ significantly both within groups and between groups (p>0.05). The anteroposterior naviculometatarsal angle was 95.3 degrees in group 1, and 96.7 degrees in group 2. The anteroposterior naviculometatarsal angle and talonavicular subluxation were similar in the two groups (p>0.05). The early and late postoperative calcaneocuboid relationship showed significant improvement in both groups, without a significant difference between the groups (p>0.05).
It seems that release of the AH muscle does not affect the incidence of postsurgical residual adduction deformity in the surgical treatment of congenital clubfoot.
我们评估了在先天性马蹄内翻足手术治疗中，拇展肌（AH）肌腱松解对残余内收畸形的影响。
该研究纳入了35例先天性马蹄内翻足患者。13例患者（第1组，21足）接受了经典的完全距下关节松解术，而22例患者（第2组，31足）接受了相同治疗并联合AH肌松解，即向足底剥离并在远端横断该肌肉。第1组的平均年龄为19.4个月（范围13至39个月），第2组为13.5个月（范围11至25个月）。第1组的平均随访期为55.5个月（范围36至77个月），第2组为24.7个月（范围10至37个月）。对术前、术后早期及最终X线片进行影像学评估，测量前后位距骨-第一跖骨角和跟骰关节关系，以及最终X线片上的前后位舟骨-跖骨角和距舟关节关系。
两组在术后早期前后位距骨-第一跖骨角均有显著改善（p<0.001）；然而，术后早期和晚期的距骨-第一跖骨角在组内及组间均无显著差异（p>0.05）。第1组的前后位舟骨-跖骨角为95.3度，第2组为96.7度。两组的前后位舟骨-跖骨角及距舟关节半脱位情况相似（p>0.05）。两组术后早期和晚期的跟骰关节关系均有显著改善，组间无显著差异（p>0.05）。
在先天性马蹄内翻足手术治疗中，AH肌松解似乎并不影响术后残余内收畸形的发生率。
