Raab P, Krauspe R
Orthopädische Universitätsklinik, König-Ludwig-Haus, Würzburg, Germany.
Orthopade. 1999 Mar;28(2):110-116. doi: 10.1007/PL00003587.
About 25 % of operated clubfeet will develop a recurrency or show a marked residual deformity. As main factor the failure of concentric reduction at the time of initial surgery has to be considered. Residual forefoot adduction and supination are the most common persistent deformities. Based on the experience with 94 recurrent/residual clubfeet (patients < 10 years) the surgical treatment at different age-groups is presented. As a general rule soft tissue release is applicable as a repeated procedure until the age of about eight to ten years. For revision in patients between two and eight years we recommend a closing wedge osteotomy of the cuboid and a tibialis transfer additional to repeated release-procedures. In patients older than eight to ten years mid-tarsal osteotomies, correction according to Ilizarov with the external fixator or triple arthrodesis are to be considered as single or combined procedures.
约25%接受手术治疗的马蹄内翻足会出现复发或明显的残留畸形。初次手术时未能实现同心复位是主要因素。残留的前足内收和旋后是最常见的持续性畸形。基于94例复发性/残留性马蹄内翻足（年龄小于10岁的患者）的经验，介绍了不同年龄组的手术治疗方法。一般来说，软组织松解可作为重复手术应用至约8至10岁。对于2至8岁患者的翻修手术，我们建议在重复松解手术的基础上，进行骰骨闭合楔形截骨术和胫前肌转移术。对于8至10岁以上的患者，可考虑采用中跗骨截骨术、使用外固定器按照伊里扎洛夫技术进行矫正或三关节融合术作为单一或联合手术。
