Department of Hand, Foot and Microsurgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Hand and Foot Surgery and Repair and Reconstruction of the Ward, Shandong Public Health Clinical Center, Shanghai, China.
Orthop Surg. 2024 Sep;16(9):2115-2122. doi: 10.1111/os.14207. Epub 2024 Sep 2.
Equinovarus deformity correction was performed by soft tissue release and bone deformity correction, and tendon transfer to maintain deformity correction. Because of the high complication rate of tendon fixation methods, partial or total anterior tibial tendon or posterior tibial tendon transfer to the peroneus tertius tendon was reported. The purpose of this study was (i) to review the results of this tendon transfer technique after release and correction of talipes equinovarus, and (ii) to analyze the complication of this technique.
Between February 2017 and May 2022, 176 patients (210 feet) with equinus and/or varus foot and ankle deformities underwent anterior or posterior tibial tendon transfer to the peroneus tertius in our institute. Preoperative and postoperative foot and ankle range of motion (passive and active) were checked. The postoperative radiographic assessment included antero-posterior (AP), lateral, and hindfoot alignment radiographs. Preoperative and postoperative lateral tibio-talar, talo-calcaneal, talo-first metatarsal, tibial-sole angles, hindfoot alignment, and anterior subluxation of the talus were checked. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale (VAS) were used to assess pain. Paired Student's t-test was used to compare the clinical scores and radiographic angles before the operation and at the last follow-up.
The mean age of the patients was 23.27 ± 13.44 years (range, 3-69 years). The mean follow-up time was 25.56 ± 16.37 months (range, 12-68 months). There were significant differences between the preoperative and postoperative measurements of the lateral tibio-talar angle, lateral talo-calcaneal angle, lateral talo-first metatarsal angle, lateral tibial-sole angle, and hindfoot alignment (p < 0.001). There was significant difference between the preoperative and postoperative AOFAS and VAS scores (p < 0.001). The early complications included infection in one patient, skin necrosis in two patients, and plantar numbness in three patients. The late complications included pin infection in three patients, tibio-talar joint compression in four patients, forefoot pain in two patients, toe flexion in two patients, and plantar numbness in one patient. There were three cases of complications (1.43%) related to the transferred tendons.
Tibialis anterior or posterior tendon transfer to the peroneus tertius is a safe and effective method for equinovarus deformity correction. It yielded excellent outcomes that produced high patient satisfaction and few complications.
马蹄内翻足畸形的矫正采用软组织松解和骨骼畸形矫正，并通过肌腱转位来维持畸形矫正。由于肌腱固定方法的高并发症率，部分或全部前胫骨肌腱或后胫骨肌腱转移到第三腓骨肌腱的报道。本研究的目的是：（i）回顾分析经松解和矫正后，行前或后胫骨肌腱转移到第三腓骨肌腱治疗马蹄内翻足畸形的结果；（ii）分析该技术的并发症。
2017 年 2 月至 2022 年 5 月，在我院，176 例（210 足）有马蹄内翻足和/或内翻足和踝关节畸形的患者行前或后胫骨肌腱转移到第三腓骨肌腱。检查术前和术后足踝的活动范围（被动和主动）。术后影像学评估包括前后位（AP）、侧位和后足对线位 X 线片。检查术前和术后外侧胫距、距跟、距舟、胫骨-足底角、后足对线和距骨前侧半脱位。采用美国矫形足踝协会（AOFAS）踝关节-后足评分和视觉模拟评分（VAS）评估疼痛。采用配对 Student t 检验比较术前和末次随访时的临床评分和影像学角度。
患者的平均年龄为 23.27±13.44 岁（范围 3-69 岁）。平均随访时间为 25.56±16.37 个月（范围 12-68 个月）。术前和术后外侧胫距角、外侧距跟角、外侧距舟角、外侧胫骨-足底角和后足对线有显著差异（p<0.001）。术前和术后 AOFAS 和 VAS 评分有显著差异（p<0.001）。早期并发症包括 1 例感染，2 例皮肤坏死，3 例足底麻木。晚期并发症包括 3 例钢针感染，4 例距下关节受压，2 例前足疼痛，2 例踇趾屈曲，1 例足底麻木。有 3 例（1.43%）与转移肌腱相关的并发症。
前或后胫骨肌腱转移到第三腓骨肌腱是治疗马蹄内翻足畸形的一种安全有效的方法。它产生了极好的结果，使患者满意度高，并发症少。
