de Carvalho Neto J, Dias L S, Gabrieli A P
Children's Memorial Medical Center, Chicago, Illinois, USA.
J Pediatr Orthop. 1996 Nov-Dec;16(6):782-5. doi: 10.1097/00004694-199611000-00015.
The results of the surgical treatment of clubfoot deformity in spina bifida by radical posteromedial-lateral release (PMLR) are presented. In all cases, the Cincinnati incision was used and the tendons excised, including the anterior tibial tendon. In 21 feet, a special K-wire was used to derotate the talus in the ankle mortise. The minimum follow-up was 2 years. The average age at surgery was 14 months. The overall results showed 63% good, 14% fair, and 23% poor results. In the 21 feet in which the talus K-wire was used, 76% had a good result, 14% fair, and 10% poor. The results were also analyzed based on the motor level. In the thoracic/high lumbar level, 50% had a poor result. In the low lumbar and sacral level groups together, of 45 feet, five had a poor result. This study shows that a radical PMLR can produce an overall good and fair result in 77% of the cases. The use of the K-wire to derotate the talus led to an improvement in the result. The tendon excision leading to a flail foot corrects any residual muscle imbalance. The poor results seen in the thoracic/high lumbar patients are likely to be related to the lack of weight bearing in view of their motor paralysis.
本文介绍了通过根治性后内侧-外侧松解术（PMLR）治疗脊柱裂马蹄内翻足畸形的手术结果。所有病例均采用辛辛那提切口，切除肌腱，包括胫前肌腱。21只足使用特殊克氏针在踝关节窝内使距骨旋转。最短随访时间为2年。手术平均年龄为14个月。总体结果显示，63%为良好，14%为一般，23%为差。在使用距骨克氏针的21只足中，76%结果良好，14%一般，10%差。还根据运动平面分析了结果。在胸段/高腰段，50%结果差。在低腰段和骶段组共45只足中，5只结果差。本研究表明，根治性PMLR在77%的病例中可产生总体良好和一般的结果。使用克氏针使距骨旋转可改善结果。导致连枷足的肌腱切除可纠正任何残留的肌肉失衡。胸段/高腰段患者结果差可能与其运动性瘫痪导致的不负重有关。
