Dungl P, Karpísek M
Ortopedická klinika ILF, Fakultní nemocnice Bulovka, Praha.
Acta Chir Orthop Traumatol Cech. 1990 Apr;57(2):111-26.
The results of the surgical treatment by the method of extensive subtalar release after McKay is observed on the group of 35 feet operated on in 23 patients. In 17 feet it was the case of the recurrence after the operation, 18 feet were operated on primarily either after the conservative therapy or after no preceding therapy. Surgical technique is described in which major stress is put on the considerate approach and perfect correction of all abnormalities within one operation. A three-grade evaluation was used for the assessment of the results: good, fair, poor. Good results were achieved in 60 per cent of operated feet, 23 percent were evaluated as fair and 17 per cent as poor results. In the group of patients operated on beforehand the number of poor results is higher than in the group of patients operated on for the first time. As a supplementary procedure enucleation of os cuboideum is applied either during the basic operation or in the following period, in the second phase metatarsal osteotomy and transposition of the tendon of m. tibialis ant. into the base of Vth metatarsal are performed. This method of surgical treatment provides very satisfactory results. With the adequate performance of surgical treatment the number of complications is minimal. This type of operation is indicated for children between 1 and 4 years of age, exceptionally it can be performed also in older patients (the oldest boy in the group was 6 years old).
对23例患者的35只脚采用麦凯（McKay）方法进行广泛距下关节松解术后的手术治疗结果进行了观察。其中17只脚术后出现复发，18只脚是在保守治疗后或未经过前期治疗直接进行初次手术。文中描述了手术技术，该技术着重于在一次手术中采取周全的方法并完美矫正所有异常情况。采用三级评估来评定结果：优、良、差。60%的手术脚取得了优的结果，23%评定为良，17%评定为差。在预先接受过手术的患者组中，差结果的数量高于首次接受手术的患者组。作为辅助操作，在初次手术期间或后续阶段进行骰骨摘除术，在第二阶段进行跖骨截骨术，并将胫前肌肌腱转位至第5跖骨基部。这种手术治疗方法取得了非常令人满意的结果。如果手术治疗操作得当，并发症数量极少。这种手术类型适用于1至4岁的儿童，特殊情况下也可在年龄较大的患者中进行（该组中年龄最大的男孩为6岁）。
