Kérő Gábor, Frigyesi László, Szabó Tamás, Than Péter, Vermes Csaba
Általános Orvostudományi Kar, Klinikai Központ, Ortopédiai Klinika,Pécsi TudományegyetemPécs, Akác u. 1., 7632.
Orv Hetil. 2020 Feb;161(8):306-312. doi: 10.1556/650.2020.31669.
The surgical solution of equinus deformity is one of the most important factors in the treatment of patients with cerebral palsy. We perform open Z achillotenotomy and percutaneus triple hemisection routinely in our department. The goal of our work was to analyze the long-term results of achillotenotomies in patients with cerebral palsy, to look for predisposing factors of major complications, and to compare the results of the performed operative methods. Between 1990 and 2006, we performed 347 surgical Achilles tendon lengthenings. In 261 cases, the operations were performed percutaneusly, and in 86 cases we performed open Z achillotenotomy. The average follow-up time was 15 years. The long-term outcomes were analyzed based on the age at surgery, the topographic appearance and the severity of cerebral palsy. Analysis regarding functional outcome was based on the widely known Physician Rating Scale system. Due to recurrent equinus deformity, re-achillotenotomy was performed in 74 cases (21.3%), and in 14 cases (4%) the re-achillotenotomy needed to be performed a second time. We encountered overcorrection and calcaneus deformity in 12 cases (3.5%). Recurrence rate was higher in patients operated at a younger age (<7 years) and in patients with a more severe cerebral palsy (GMFCS II-III, ~26%). Recurrence showed accumulation in patients 9-14 years old. The major complication we encountered was recurrence of the equinus deformity. The majority of relapses occured in patients who were operated at a younger age and suffered from a more severe form of cerebral palsy. We observed that recurrence showed an association with growth and accumulated in aldolescence. Orv Hetil. 2020; 161(8): 306-312.
马蹄足畸形的手术矫正方法是治疗脑瘫患者最重要的因素之一。我们科室常规开展开放性Z形跟腱切断术和经皮三点半腱切断术。我们工作的目标是分析脑瘫患者跟腱切断术的长期疗效，寻找主要并发症的诱发因素，并比较所采用手术方法的效果。1990年至2006年期间，我们共进行了347例跟腱延长手术。其中261例采用经皮手术，86例采用开放性Z形跟腱切断术。平均随访时间为15年。基于手术时的年龄、脑瘫的局部表现和严重程度对长期疗效进行分析。功能结局分析基于广为人知的医师评分量表系统。由于马蹄足畸形复发，74例（21.3%）患者进行了再次跟腱切断术，14例（4%）患者需要进行第二次再次跟腱切断术。我们发现12例（3.5%）患者出现过度矫正和跟骨畸形。年龄较小（<7岁）和脑瘫程度较重（GMFCS II - III级，约26%）的患者复发率较高。复发在9 - 14岁的患者中呈累积趋势。我们遇到的主要并发症是马蹄足畸形复发。大多数复发发生在年龄较小且脑瘫病情较重的患者中。我们观察到复发与生长有关，并在青春期累积。《匈牙利医学周报》。2020年；161(8): 306 - 312。
