Seringe R, Martin G, Katti E, Vaquier J
Service de Chirurgie orthopédique infantile de l'Hôpital Saint-Vincent-de-Paul.
Rev Chir Orthop Reparatrice Appar Mot. 1990;76(4):234-44.
The authors have studied the pathological anatomy of two congenital pes convex, (C.P.C) coming from an 8 days boy suffering of arthrogryposis. One of the feet has been dissected by stage whilst the other one has been operated on according to a procedure of correction of the deformities. The two feet combined an irreducible dislocation of the os naviculare on the neck of the talus, a calcaneo cuboïdeum subluxation, a moderate equinus of the hind foot, an important contracture of the extensor tendons and an elongation of the structural soft tissues of the sole. The main abnormalities of the talus and of the calcaneus involved the upper direction of the anterior articular facet, in relation to the dorsal dislocation of the os naviculare and the dorsal subluxation of the cuboïdeum. The subtalaris joint was little altered. The study of dissections and the clinical reports published connected with the observations of the authors confirm the pre-eminence of the transversal dislocation of the tarsus and of its irreducibility. On the other hand the abnormalities of the subtalar joint have been, probably over estimated. The sometimes important increase of talo calcaneal angle on A.P. radiographies may be explained by the incidence itself. The verticality of the talus is not a reliable feature of C.P.C. and the deformities of the fore foot are variable (pronation, supination). This study leads to a new definition of the C.P.C.: Congenital deformity of the foot with tarsi-transversa dislocation or subluxation involving mainly the talo-navicular joint. The criterious of diagnosis are debated and a logical surgical procedure of correction is suggested.
作者研究了一名患有先天性多发性关节挛缩症的8日龄男婴的两只先天性凸足（C.P.C）的病理解剖结构。其中一只脚进行了分期解剖，另一只则按照畸形矫正程序进行了手术。两只脚均存在舟骨在距骨颈上的不可复位脱位、跟骰关节半脱位、后足中度马蹄足、伸肌腱严重挛缩以及足底结构软组织伸长。距骨和跟骨的主要异常涉及前关节面向上移位，这与舟骨背侧脱位和骰骨背侧半脱位有关。距下关节改变较小。解剖研究以及与作者观察结果相关的已发表临床报告证实了跗骨横向脱位及其不可复位性的突出地位。另一方面，距下关节的异常可能被高估了。前后位X线片上有时明显增大的距跟角可能由发病率本身来解释。距骨的垂直性并非C.P.C的可靠特征，前足畸形可变（内旋、外旋）。本研究得出了C.P.C的新定义：主要累及距舟关节的跗骨横向脱位或半脱位的先天性足部畸形。讨论了诊断标准并提出了合理的矫正手术程序。
