Department of Paediatric Orthopaedics.
Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Speising, Vienna, Austria.
J Pediatr Orthop. 2020 Sep;40(8):418-424. doi: 10.1097/BPO.0000000000001542.
We aimed to evaluate the effect of tibialis anterior tendon transfer (TATT) on foot motion in children with clubfoot recurrence after initial Ponseti treatment.
Children with dynamic clubfoot recurrence after initial Ponseti treatment who underwent TATT between 2014 and 2017 were considered for inclusion. Exclusion criteria were neurological disease, split transfer of the tendon, additional bone or joint invasive surgery, and initial treatment abroad. Of 94 children (143 TATT), 36 met the inclusion criteria. Seventeen (47%) of the 36 children with 25 clubfeet and a mean age at the time of surgery of 6.8 years participated in the study. Gait analysis, including the Oxford foot model, was conducted preoperatively and postoperatively. Furthermore, kinematic and kinetic data were compared with those of age-matched healthy children (n=18).
Forefoot supination in relation to the hindfoot and tibia was reduced during swing and at initial contact after TATT compared with preoperative values. Forefoot supination in relation to the tibia at initial contact decreased from 12.4 to 5.2 degrees after TATT (control group, 6.0 degrees). The heel showed less dynamic varus and adduction movement after TATT compared with preoperatively. Maximum ankle power was reduced preoperatively and postoperatively compared with controls. Maximum ankle dorsiflexion slightly increased after TATT.
Gait analysis showed normalization of the main components of dynamic clubfoot recurrence after TATT. This joint-sparing surgery efficiently corrects recurrent dynamic deformity.
Level II-therapeutic.
我们旨在评估胫前肌腱转移（TATT）对初始 Ponseti 治疗后复发马蹄足患儿足部运动的影响。
考虑纳入 2014 年至 2017 年间接受 TATT 的初始 Ponseti 治疗后出现动态马蹄足复发的患儿。排除标准为神经疾病、肌腱分裂转移、额外的骨或关节侵袭性手术以及国外的初始治疗。在 94 名儿童（143 例 TATT）中，36 名符合纳入标准。36 名患儿中有 17 名（47%）接受了 25 例马蹄足手术，手术时的平均年龄为 6.8 岁。术前和术后均进行步态分析，包括牛津足模型。此外，还将运动学和动力学数据与年龄匹配的健康儿童（n=18）进行了比较。
与术前相比，TATT 后摆动期和初始接触时后足和胫骨相对于前足的旋前减少。TATT 后初始接触时胫骨相对于前足的旋前从 12.4 度减少到 5.2 度（对照组为 6.0 度）。与术前相比，TATT 后足跟显示出较少的动态内翻和内收运动。与对照组相比，术前和术后最大踝关节功率均降低。TATT 后最大踝关节背屈度略有增加。
步态分析显示 TATT 后动态马蹄足复发的主要成分得到了正常化。这种关节保存手术有效地纠正了复发性动态畸形。
II 级-治疗。
