Chung Chin Youb, Sung Ki Hyuk, Lee Kyoung Min, Lee Seung Yeol, Choi In Ho, Cho Tae-Joon, Yoo Won Joon, Park Moon Seok
*Department of Orthopaedic Surgery, Seoul National University Bundang Hospital †Department of Orthopaedic Surgery, Myongji Hospital, Kyungki ‡Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul, Korea.
J Pediatr Orthop. 2015 Jun;35(4):419-25. doi: 10.1097/BPO.0000000000000278.
Recurrence of equinus deformity after surgery is common in patients with cerebral palsy. This retrospective study was undertaken to estimate the recurrence rate of the equinus deformity after tendo-Achilles lengthening (TAL) in patients with cerebral palsy and to investigate the risk factors associated with the recurrence.
Two-hundred forty three ambulatory patients with cerebral palsy, who underwent TAL for equinus foot deformity since 1995, and had undergone a preoperative and postoperative 3-dimensional gait analysis, were included. Cox proportional hazards model was used to determine the significant contributing factor for the recurrence of equinus foot deformity.
The mean patient age at surgery was 7.8±2.7 years and the mean follow-up duration was 8.1±3.4 years. Equinus deformity recurred in 22 of the 243 patients (9.1%) and the Kaplan-Meier survival estimate was shown to be 89.4% at 10 years not needing repeat surgery. According to the multivariate analysis using the Cox proportional hazard model, preoperative ankle dorsiflexion at initial contact (P=0.016) was the only significant factor for recurrence of equinus deformity after surgery. Age at surgery and the type of limb involvement were not associated with the recurrence (P=0.433 and 0.269). The cutoff values of preoperative gait kinematics between the nonrecurrence and recurrence groups were -19 degrees of ankle dorsiflexion at initial contact (P=0.018).
This study showed that the severity of preoperative equinus deformity was a risk factor associated with recurrence after TAL in patients with cerebral palsy. Therefore, surgeons should consider the recurrence and later revision surgery for the patients with severe equinus foot deformity.
Therapeutic level III.
跟腱延长术后马蹄足畸形复发在脑瘫患者中很常见。本回顾性研究旨在评估脑瘫患者跟腱延长术（TAL）后马蹄足畸形的复发率，并调查与复发相关的危险因素。
纳入243例自1995年以来因马蹄足畸形接受TAL手术且术前行三维步态分析和术后行三维步态分析的脑瘫门诊患者。采用Cox比例风险模型确定马蹄足畸形复发的显著影响因素。
手术时患者的平均年龄为7.8±2.7岁，平均随访时间为8.1±3.4年。243例患者中有22例（9.1%）出现马蹄足畸形复发，Kaplan-Meier生存估计显示10年时无需再次手术的概率为89.4%。根据使用Cox比例风险模型的多因素分析，初始接触时术前踝关节背屈角度（P=0.016）是术后马蹄足畸形复发的唯一显著因素。手术年龄和肢体受累类型与复发无关（P=0.433和0.269）。非复发组和复发组术前步态运动学的临界值为初始接触时踝关节背屈-19度（P=0.018）。
本研究表明，术前马蹄足畸形的严重程度是脑瘫患者TAL术后复发的一个危险因素。因此，外科医生应考虑严重马蹄足畸形患者的复发及后期翻修手术。
治疗性III级。
