Napiontek M, Nazar J
Department of Pediatric Orthopaedics, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
J Pediatr Orthop. 1994 Nov-Dec;14(6):763-7. doi: 10.1097/01241398-199414060-00014.
Fourteen children (19 feet) ranging in age from 2.1 to 17.0 years (mean, 7.6 years) underwent tibial osteotomy for treatment of congenital talipes equinovarus (CTEV). The indications for tibial osteotomy were persistent or recurrent equinovarus deformity and internal rotation of the foot (medial malalignment syndrome), in most cases with severe distortion of the hindfoot joints resulting from previous operations. In 12 feet (9 children), bi- or triplanar supramalleolar osteotomy for the correction of all the elements of the deformity was performed. In the remaining cases, external rotation tibial osteotomy below the tuberosity in five feet (three children) and supramalleolar in two feet (two children) was performed. The follow-up ranged from 1 to 16 years (mean, 4.3 years). Partial or full improvement, concerning one or more elements of the equinovarus deformity, has been achieved in 11 feet (nine children). In eight feet (five children), tibial osteotomy did not improve the deformity. There are exceptionally rare indications for use of tibial osteotomy in the treatment of CTEV or medial malalignment syndrome after failed clubfoot surgery. They concern older children and adolescents with secondary osteoarthritis of the feet resulting from previous multiple operations.
14名年龄在2.1岁至17.0岁（平均7.6岁）的儿童（19只脚）接受了胫骨截骨术以治疗先天性马蹄内翻足（CTEV）。胫骨截骨术的适应症为持续性或复发性马蹄内翻畸形以及足部内旋（内侧对线不良综合征），在大多数情况下，由于先前的手术导致后足关节严重扭曲。在12只脚（9名儿童）中，进行了双平面或三平面距上截骨术以矫正畸形的所有要素。在其余病例中，对5只脚（3名儿童）在胫骨结节下方进行了外旋胫骨截骨术，对2只脚（2名儿童）进行了距上截骨术。随访时间为1至16年（平均4.3年）。11只脚（9名儿童）在马蹄内翻畸形的一个或多个要素方面实现了部分或完全改善。在8只脚（5名儿童）中，胫骨截骨术未改善畸形。在先天性马蹄内翻足手术失败后治疗CTEV或内侧对线不良综合征时，使用胫骨截骨术的适应症极为罕见。它们涉及因先前多次手术导致足部继发性骨关节炎的大龄儿童和青少年。
