Böhm K, Carstens C
Orthopädische Universitätsklinik Heidelberg Abteilung für Orthopädie im Kindesalter.
Z Orthop Ihre Grenzgeb. 1996 Mar-Apr;134(2):155-60. doi: 10.1055/s-2008-1039788.
Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.
1974年至1991年间，作者所在诊所对65例患有脊髓脊膜膨出的患者的100例马蹄内翻畸形进行了一期手术。我们治疗的目的是使足部达到跖行位，以便能够使用矫形器。75%的患者在首次手术后达到了这一效果，25%的患者需要再次手术。切口采用辛辛那提切口方式。根据瘫痪的程度和类型，手术治疗必须进行调整。我们在第1组（胸段至L2）中取得了良好的治疗效果，64%的患者足部达到跖行位，在第3组（L5至骶段）中这一比例为61%。第2组（L4至L5）情况较差，为32%。在所有类型的瘫痪中，进行肌腱切断术时效果更好。应切断瘫痪的肌肉，对有神经支配的肌肉进行延长以保持其功能。重要的是重建肌肉平衡。当存在前足内翻时，需要充分进行内侧松解。术后使用石膏固定8至12周，之后穿特制鞋子，并在夜间使用支具。与特发性马蹄内翻畸形的治疗相应，治疗应在出生后开始，并在患儿开始直立行走时完成。
