Thometz John, Sathoff Lance, Liu Xue Cheng, Jacobson Richard, Tassone J Channing
Department of Orthopaedic Surgery, Children's Hospital of Wisconsin,Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
Am J Orthop (Belle Mead NJ). 2011 Feb;40(2):84-6.
Neurologic deficit has been implicated as a possible etiology for clubfoot and a cause for recurrent deformity in patients who have undergone clubfoot surgery. In the study reported here, we wanted to determine if clubfoot patients with peroneal weakness had any neurologic deficits on electromyography nerve conduction velocity (EMG-NCV) studies before surgery and if there was any association between neurologic deficit and clubfoot recurrence. We reviewed the EMG-NCV studies of 36 patients involving 57 cases of idiopathic clubfoot and recurrence of the deformity or muscle weakness. In the clubfoot patients with weak peroneal muscle and no prior surgical history, 45% of the studies were interpreted as normal, 20% as neuropathic, 15% as mixed myopathic and neuropathic, 10% as radicular, and 10% as myopathic. In the clubfoot patients with recurrence after clubfoot repair surgeries, 57% had abnormal EMG-NCV studies. Specifically, peroneal mononeuropathy was the most common disorder (41% of clubfoot patients treated surgically). Awareness of a significant incidence of neurologic deficit may help in preoperative planning by indicating that ultimately a tendon transfer may be necessary to obtain a plantigrade foot.
神经功能缺损被认为是马蹄内翻足可能的病因，也是马蹄内翻足手术后畸形复发的原因。在本文报道的研究中，我们想确定术前腓骨肌无力的马蹄内翻足患者在肌电图神经传导速度（EMG-NCV）检查中是否存在任何神经功能缺损，以及神经功能缺损与马蹄内翻足复发之间是否存在关联。我们回顾了36例患者的EMG-NCV检查结果，这些患者涉及57例特发性马蹄内翻足及畸形复发或肌肉无力的病例。在腓骨肌无力且无既往手术史的马蹄内翻足患者中，45%的检查结果被判定为正常，20%为神经性，15%为混合性肌病性和神经性，10%为神经根性，10%为肌病性。在马蹄内翻足修复手术后复发的患者中，57%的EMG-NCV检查结果异常。具体而言，腓总神经单神经病是最常见的疾病（接受手术治疗的马蹄内翻足患者中有41%）。认识到神经功能缺损的高发生率可能有助于术前规划，因为这表明最终可能需要进行肌腱转移以获得足底着地的足部。
