Holt Joshua B, Oji David E, Yack H John, Morcuende Jose A
Ponseti Clubfoot Treatment Center (J.B.H., D.E.O., and J.A.M.) and Orthopaedic Gait Analysis Laboratory (H.J.Y.), Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for J.B. Holt:
J Bone Joint Surg Am. 2015 Jan 7;97(1):47-55. doi: 10.2106/JBJS.N.00525.
Relapse of idiopathic clubfoot deformity after treatment can be effectively managed with repeat casting and tibialis anterior tendon transfer during early childhood. We evaluated the long-term effects on adult foot function after tibialis anterior tendon transfer for relapsed idiopathic clubfoot deformity during childhood.
Thirty-five patients (sixty clubfeet) in whom idiopathic clubfoot was treated with the Ponseti method from 1950 to 1967 were followed. At an average age of forty-seven years (range, thirty-seven to fifty-five years), the patients underwent a detailed musculoskeletal examination, radiographic evaluation, pedobarographic analysis, and surface electromyography (EMG). They also completed three quality-of-life patient questionnaires.
Fourteen patients (twenty-five clubfeet, 42%) had required repeat casting and tibialis anterior tendon transfer in childhood for relapsed clubfoot deformity after initial casting and served as the study group. Twenty-one patients (thirty-five clubfeet, 58%) were successfully treated with initial casting without relapse (the reference group). No patient in either group had subsequent relapse or required additional operative intervention associated with clubfoot deformity. The mean ankle dorsiflexion was similar between the groups. Radiographically, the tendon transfer group showed a smaller mean anteroposterior talocalcaneal angle and slightly more talar flattening than the reference group with no associated clinical differences. Peak pressures, total force distribution, and surface EMG results were not significantly different between the groups. Outcome questionnaires demonstrated no significant difference between the groups.
Tibialis anterior tendon transfer is very effective at preventing additional relapse of deformity without affecting long-term foot function of patients with idiopathic clubfoot.
特发性马蹄内翻足畸形治疗后复发，在儿童早期可通过重复石膏固定和胫前肌腱转移有效处理。我们评估了儿童期复发性特发性马蹄内翻足畸形行胫前肌腱转移术后对成人足部功能的长期影响。
对1950年至1967年采用Ponseti方法治疗特发性马蹄内翻足的35例患者（60足）进行随访。患者平均年龄47岁（范围37至55岁），接受了详细的肌肉骨骼检查、影像学评估、足底压力分析和表面肌电图（EMG）检查。他们还完成了三份生活质量患者问卷。
14例患者（25足，42%）儿童期因初次石膏固定后马蹄内翻足畸形复发而需要重复石膏固定和胫前肌腱转移，作为研究组。21例患者（35足，58%）初次石膏固定治疗成功且未复发（参照组）。两组均无患者随后复发或需要与马蹄内翻足畸形相关的额外手术干预。两组之间平均踝关节背屈相似。影像学上，肌腱转移组平均距跟前后角较小，距骨扁平略多于参照组，但无相关临床差异。两组之间峰值压力、总力分布和表面肌电图结果无显著差异。结果问卷显示两组之间无显著差异。
胫前肌腱转移在预防特发性马蹄内翻足患者畸形进一步复发方面非常有效，且不影响其足部长期功能。
