Eidelman Mark, Keren Yaniv, Katzman Alexander
Pediatric Orthopedic Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
J Pediatr Orthop. 2012 Jul-Aug;32(5):527-33. doi: 10.1097/BPO.0b013e318259ff2d.
Residual clubfoot deformities in older children are a difficult surgical problem. The foot is stiff and almost always has already undergone some surgical intervention. The traditional approach includes soft-tissue release or osteotomy and external fixation (usually with an Ilizarov frame).
In this study, we summarized our experience with the treatment of residual clubfoot deformities in older children using a percutaneous midfoot Gigli saw osteotomy and the Taylor spatial frame. There were 11 children in the study, with a mean age of 14.7 years, and mean frame fixation time was 15.1 weeks. Because the primary problems in these children were midfoot and forefoot deformities (forefoot adduction, supination, and cavus), a Butt frame was applied after the midfoot osteotomy.
At the time of frame removal, the goal of deformity correction was achieved in all the children. Two patients had partial recurrence of the deformities and were reoperated. One patient with residual supination is planned to be operated close to maturity. Complications included superficial pin-tract infection in 5 patients and premature consolidation of the osteotomy that needed reosteotomy.
On the basis of our experience, we believe that midfoot osteotomy and correction by Taylor spatial frame is an effective and reliable surgical option for this challenging problem.
Level 4--case series.
大龄儿童残留的马蹄内翻足畸形是一个棘手的外科问题。足部僵硬，几乎总是已经接受过一些外科干预。传统方法包括软组织松解或截骨术以及外固定（通常使用伊里扎洛夫架）。
在本研究中，我们总结了使用经皮中足吉列锯截骨术和泰勒空间架治疗大龄儿童残留马蹄内翻足畸形的经验。研究中有11名儿童，平均年龄为14.7岁，平均框架固定时间为15.1周。由于这些儿童的主要问题是中足和前足畸形（前足内收、旋后和高弓足），在中足截骨术后应用了巴特架。
在拆除框架时，所有儿童均实现了畸形矫正目标。2例患者畸形部分复发并接受了再次手术。1例残留旋后的患者计划在接近成年时进行手术。并发症包括5例患者发生浅表针道感染以及截骨过早愈合需要再次截骨。
基于我们的经验，我们认为中足截骨术和泰勒空间架矫正对于这个具有挑战性的问题是一种有效且可靠的手术选择。
4级——病例系列。
