脑性瘫痪患儿马蹄内翻足的胫前肌腱转位至第三腓骨肌腱分期转移术
The split transfer of tibialis anterior tendon to peroneus tertius tendon for equinovarus foot in children with cerebral palsy.
作者信息
Sarıkaya İlker Abdullah, Birsel Sema Ertan, Şeker Ali, Erdal Ozan Ali, Görgün Barış, İnan Muharrem
机构信息
Department of Orthopaedics and Traumatology, Ortopediatri Academy of Pediatric Otrhopaedics, İstanbul, Turkey.
Department of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 May;54(3):262-268. doi: 10.5152/j.aott.2020.03.571.
OBJECTIVE
The aim of this study was to analyze the results of the split anterior tibialis tendon transfer (SPLATT) to peroneus tertius (PT) for equinovarus foot deformity in children with cerebral palsy (CP).
METHODS
The medical records of 25 ambulatory CP patients (mean age: 8.7±3.2 years, range: 4-16 years) with equinovarus foot (33 feet), who underwent SPLATT to PT surgery between 2014 and 2016, were retrospectively reviewed. A senior surgeon performed all the surgical procedures. SPLATT was performed as part of a single-event multilevel surgery for the lower limb, and the concomitant procedures on the same extremity were recorded. The patients who required any additional foot or ankle surgery that could affect the clinical outcome (except heel cord lengthening) were excluded from the study. The Kling's College Criteria were used to evaluate the procedural outcome of the foot position and gait, and the associated complications were recorded.
RESULTS
The mean follow-up time was 28.8±5 months (range: 24-42 months). The postoperative Kling scores were excellent for 27 feet of the patients who had a plantigrade foot, without fixed or postural deformity, in a regular shoe, having no calluses; good for 5 cases for those who walked with less than 5° varus, valgus, or equinus posture of the hind foot, wearing regular shoes, having no callosities; and fair for 1 case for those who had recurrence of the deformity. There was only one wound detachment, which was treated with wound care and dressing. None of the patients had overcorrection, infection, or bone fracture.
CONCLUSION
The dynamic SPLATT to PT surgery for the management of the equinovarus foot deformities in the CP patients is a safe and less complicated surgical alternative with a good functional outcome. It is a safe and effective treatment method for the management of equinovarus foot deformities in CP.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
本研究旨在分析将胫骨前肌腱劈开转移（SPLATT）至第三腓骨肌（PT）治疗脑瘫（CP）患儿马蹄内翻足畸形的结果。
方法
回顾性分析2014年至2016年间接受SPLATT至PT手术的25例能行走的CP患儿（平均年龄：8.7±3.2岁，范围：4 - 16岁）的病历，这些患儿均有马蹄内翻足（33只足）。所有手术均由一位资深外科医生完成。SPLATT作为下肢单期多平面手术的一部分进行，并记录同一肢体的伴随手术。需要进行任何可能影响临床结果的额外足踝手术（跟腱延长除外）的患者被排除在研究之外。采用克林学院标准评估足部位置和步态的手术结果，并记录相关并发症。
结果
平均随访时间为28.8±5个月（范围：24 - 42个月）。术后克林评分中，27只足为优，这些患儿足部呈平足，无固定或姿势性畸形，穿普通鞋，无胼胝；5例为良，这些患儿后足内翻、外翻或马蹄姿势小于5°，穿普通鞋，无胼胝；1例为中，该患儿畸形复发。仅发生1例伤口裂开，经伤口护理和换药处理。所有患者均未出现过度矫正、感染或骨折。
结论
对于CP患儿马蹄内翻足畸形，采用动态SPLATT至PT手术是一种安全、并发症少且功能结局良好的手术选择。它是治疗CP患儿马蹄内翻足畸形的一种安全有效的治疗方法。
证据级别
IV级，治疗性研究。
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