Gaber Karim, Mir Basit, Shehab Mohammed, Kishta Waleed
Department of Orthopaedic Surgery, Mansoura International Hospital, Mansoura, Egypt.
Faculty of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Manama, Bahrain.
Curr Rev Musculoskelet Med. 2022 Apr;15(2):75-81. doi: 10.1007/s12178-022-09739-6. Epub 2022 Feb 4.
This article focuses on the current advances in surgical management for clubfoot deformity, supported by up-to-date longitudinal studies on each approach.
Long-term analysis following primary and repeated soft tissue releases has demonstrated good results in young patients with low relapse rates. Tibialis anterior transfer following the Ponseti method shows no difference in long-term pedographic analysis in comparison to the Ponseti method alone. Furthermore, tibialis anterior transfer following surgical relapses provides good long-term results with improved correction in talus-first metatarsal angle. Bony osteotomies may also play a role in addressing surgical relapses in older children. However, talar neck osteotomy may result in avascular necrosis of the talar dome. Hexapod external fixation may be considered by experienced surgeons to correct rigid clubfoot deformities in older patients with good long-term results and drastic improvements in pain perception. Long-term analysis of anterior distal tibial epiphysiodesis (ADTE) for recurrent equinus deformity following surgical correction has demonstrated statistical improvements in the anterior distal tibial angle (ADTA) and ankle dorsiflexion. Talectomy and naviculectomy are rarely used in today's practice as long-term studies have demonstrated high relapse rates and residual pain impeding patient mobility. Surgical correction following failure of the conservative approaches can be implemented to achieve full correction in clubfoot deformity. It is difficult to achieve a plantigrade feet with pain-free gait with repeated surgical interventions. Therefore, proper choice of the initial surgical technique is essential for achieving satisfactory long-term outcomes.
本文重点介绍马蹄内翻足畸形手术治疗的当前进展，并辅以每种方法的最新纵向研究。
对初次及重复软组织松解术后的长期分析表明，年轻患者效果良好，复发率低。与单独使用庞塞蒂方法相比，庞塞蒂方法后行胫前肌转移在长期足印分析中无差异。此外，手术复发后行胫前肌转移可获得良好的长期效果，距骨-第一跖骨角矫正改善。截骨术也可能在解决大龄儿童手术复发问题中发挥作用。然而，距骨颈截骨可能导致距骨穹窿缺血性坏死。经验丰富的外科医生可考虑使用六足外固定器来矫正大龄患者的僵硬马蹄内翻足畸形，长期效果良好，疼痛感知有显著改善。对手术矫正后复发性马蹄畸形行胫骨远端前骨骺阻滞术（ADTE）的长期分析表明，胫骨远端前角（ADTA）和踝关节背屈有统计学上的改善。由于长期研究表明距骨切除术和舟骨切除术复发率高且残留疼痛妨碍患者活动，如今很少使用。保守方法失败后可实施手术矫正以实现马蹄内翻足畸形的完全矫正。通过反复手术干预很难实现无痛步态的足底着地足部。因此，正确选择初始手术技术对于获得满意的长期效果至关重要。
