Das Premal, Kumar Julius, Karthikeyan G, Rao P S S Sundar
TLM Community Hospital Naini, Allahabad, Uttar Pradesh, India.
TLM RRC, Noida, Uttar Pradesh, India.
Lepr Rev. 2013 Sep;84(3):186-93.
Tibialis posterior tendon transfer (TPT) technique, using either the Circum-tibial (CT) or Inter-osseus (IO) route is the standard surgical technique to correct foot drop. The selection of the route of transfer is usually dependent on the surgeon's preference. This study aims to identify criteria to help make that selection.
A study was carried out on 381 feet during the period 1999 to 2010. All the patients operated during this period were included in the study. The CT route was used for those with peronei power 4 or 5, while the IO route was used when peronei power was 3 or less.
In this case series the mean effective range of motion (above 90 degrees) was 11 and 12 degrees in CT and IO routes, respectively. The results were comparable in terms of rest position, active dorsiflexion and effective range of motion. All patients had a post-operative heel to toe gait, except for one of the 381 operated feet. Only three of the 381 feet had a reduction in navicular height of more than 2 cm, the medial arch being maintained in the others.
TPT is a standard procedure to correct foot drop deformity in leprosy. Pre-selection for route of transfer, CT or IO, based on peronei strength avoids the complication of iatrogenic inversion. The technique of insertion and routine tendo-achilles lengthening provides a good range of movement. The deep tunnelling has not compromised the results, while giving excellent cosmetic appearance.
胫后肌腱转移（TPT）技术，采用绕胫骨（CT）或骨间（IO）路径，是矫正足下垂的标准手术技术。转移路径的选择通常取决于外科医生的偏好。本研究旨在确定有助于做出该选择的标准。
对1999年至2010年期间的381只脚进行了一项研究。在此期间接受手术的所有患者均纳入研究。对于腓骨肌力为4级或5级的患者采用CT路径，而当腓骨肌力为3级或更低时采用IO路径。
在这个病例系列中，CT和IO路径的平均有效活动范围（超过90度）分别为11度和12度。在静止位置、主动背屈和有效活动范围方面，结果具有可比性。除了381只接受手术的脚中的一只外，所有患者术后均呈现足跟到足尖的步态。381只脚中只有3只舟状骨高度降低超过2厘米，其他脚的内侧足弓得以维持。
TPT是矫正麻风足下垂畸形的标准手术。根据腓骨肌力对转移路径（CT或IO）进行预先选择可避免医源性内翻的并发症。插入技术和常规跟腱延长可提供良好的活动范围。深部隧道操作并未影响结果，同时外观极佳。
