Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Foot (Edinb). 2022 Sep;52:101922. doi: 10.1016/j.foot.2022.101922. Epub 2022 Mar 16.
Achilles tenotomy (AT) forms an important aspect of Ponseti's casting method and is performed in 80-90% of idiopathic clubfoot cases to correct residual hindfoot equinus. Different techniques are described in the literature with no clarity on which method is superior. This review aims to analyse the various techniques described, anaesthesia preferences, and outcomes of AT.
We searched PubMed, Embase, Scopus, and Ovid MEDLINE for articles describing idiopathic clubfoot cases undergoing primary AT during Ponseti's casting method. Data were extracted from eligible studies for qualitative and quantitative synthesis. The repeat tenotomy and complication rates were taken as outcome parameters.
Nineteen studies were included for systematic review. A percutaneous AT using a scalpel or needle is adequate in most cases and shows promising results. The out-patient department (OPD) tenotomies under local anaesthesia (LA) and operation room (OR) tenotomies under general anaesthesia (GA) were associated with a repeat tenotomy (RT) rate of 2.5% (95%CI, 0.4-5.4%) and 0.8% (95%CI, 0-1.6%), respectively. The difference between OPD and OR groups was not statistically significant (p = 0.875). The pooled analysis shows a failure/relapse rate of 4.2% (1.9-6.4%, p < 0.001) after AT. OPD and OR tenotomies were associated with a complication rate of 1.6% (95%CI, 0.2-3.0%) and 0.5% (95%CI, 0.1-0.8%), respectively, and the difference was not statistically significant (p = 0.807). Bleeding is the most common complication and is controlled in most cases by applying local pressure.
Performing Achilles tenotomy in OPD under LA is safe and cost-effective with similar success rates to those done under GA. With the lack of many comparative and higher-level evidence studies at present, we can't conclude if one technique is better than another.
跟腱切断术（Achilles tenotomy，AT）是潘塞提石膏矫形法的重要组成部分，约 80-90%的特发性马蹄内翻足病例需要进行该手术以纠正残余的跟骨马蹄。文献中描述了多种不同的技术，但哪种方法更优尚不清楚。本综述旨在分析各种描述的技术、麻醉偏好和跟腱切断术的结果。
我们在 PubMed、Embase、Scopus 和 Ovid MEDLINE 中检索了描述在潘塞提石膏矫形法中进行初次跟腱切断术的特发性马蹄内翻足病例的文章。从合格的研究中提取数据进行定性和定量综合。重复跟腱切断术和并发症的发生率作为结局参数。
19 项研究被纳入系统综述。使用手术刀或针的经皮跟腱切断术在大多数情况下是足够的，且结果有前景。在门诊局部麻醉（LA）下进行的门诊跟腱切断术和在手术室全身麻醉（GA）下进行的手术跟腱切断术的重复跟腱切断术（RT）发生率分别为 2.5%（95%CI，0.4-5.4%）和 0.8%（95%CI，0-1.6%）。门诊组和手术室组之间的差异无统计学意义（p=0.875）。汇总分析显示，跟腱切断术后失败/复发率为 4.2%（1.9-6.4%，p<0.001）。门诊和手术室跟腱切断术的并发症发生率分别为 1.6%（95%CI，0.2-3.0%）和 0.5%（95%CI，0.1-0.8%），差异无统计学意义（p=0.807）。出血是最常见的并发症，大多数情况下通过局部压迫即可控制。
在 LA 下于门诊进行跟腱切断术是安全且具有成本效益的，其成功率与 GA 下进行的相似。鉴于目前缺乏许多比较性和更高水平的证据研究，我们无法确定哪种技术优于另一种技术。
