Zimbler S, Craig C L
Foot Ankle. 1983 Jan-Feb;3(4):211-9. doi: 10.1177/107110078300300406.
Fifty-one arthrogrypotic feet have been treated and followed by the Pediatric Orthopaedic Unit, Tufts New England Medical Center, (1970-1980). Forty of the 51 feet presented as equinovarus with the residual divided among metatarsus adductus, vertical tali, and calcaneovalgus. Equinovarus deformities are the most resistant in all cases. Corrective casts are applied for at least the first 3 months of life. Surgical procedures were then initiated with any evidence of lack of progression of treatment. Varus and equinus were treated by an extensive posterior and medial release. Lateral soft tissue releases in addition to calcaneocuboid fusion or cuboid osteotomy were necessary in 24 of the 70 operations. Recurrence rate has been a problem in the simple type of posterior release including only an Achilles tendon lengthening, and posterior capsulotomy of the ankle and subtalar joint. Talectomy has been carried out in four feet and appears to be one type of reasonable salvage procedure in smaller children with recurrent varus. Treatment is difficult in these patients but a plantigrade foot should be achieved in all cases.
塔夫茨新英格兰医疗中心小儿骨科（1970 - 1980年）对51例先天性多发性关节挛缩症足部病例进行了治疗和随访。51例足部中，40例表现为马蹄内翻足，其余为内收跖骨、垂直距骨和跟骨外翻。在所有病例中，马蹄内翻足畸形最难矫正。出生后的前3个月至少应用矫正石膏。若有治疗进展停滞的迹象，则开始手术治疗。内翻和马蹄畸形采用广泛的后侧和内侧松解术治疗。在70例手术中，24例除跟骰关节融合或骰骨截骨外还需要进行外侧软组织松解。在单纯的后侧松解术（仅包括跟腱延长、踝关节和距下关节后关节囊切开术）中，复发率一直是个问题。已对4例足部进行了距骨切除术，对于复发内翻的较小儿童，这似乎是一种合理的挽救手术。这些患者的治疗很困难，但所有病例都应实现足底负重。
