Haasbeek J F, Wright J G
Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Orthop. 1997 Jan-Feb;17(1):29-35.
This study compared the long-term results of posterior and comprehensive release in the treatment of clubfoot. Patients were eligible for this study if the clubfoot was idiopathic and treatment was performed before 2 years of age. Medical records were reviewed to obtain the age, sex, bilaterality, and details of surgical treatment. Posterior release (performed before 1971) consisted of Achilles tendon lengthening and posterior ankle and subtalar releases. The comprehensive release, as described by Carroll, was performed after 1972. At the time of final review, patients completed Ponsetti's functional 100-point grading system, were examined, and had foot radiographs performed. Of 81 eligible patients, 59 (72%) were reviewed. Children in the two groups were not significantly different at the time of surgery for age, sex, and bilaterality. The patients were evaluated an average of 28 years (range, 25-30) after surgery in the posterior-release group and 16 years (range, 13-20) after surgery in the comprehensive-release group. Ponsetti scores were higher in the comprehensive-release group (mean, 86 vs. 81) but were not significantly different (p = 0.13). The comprehensive-release group required fewer procedures per patient compared with the posterior-release group (1.5 procedures vs. 2.0; p = 0.04). The ankle range of motion was similar in the two groups (p = 0.12), but the percentage of patients with subtalar stiffness was higher in the posterior-release group (50 vs. 18%; p = 0.01). Although the two groups were not statistically different based on the function-weighted Ponsetti scale, the comprehensive group had fewer operations, more complete correction of heel varus, and improved subtalar motion.
本研究比较了后路松解术与综合松解术治疗马蹄内翻足的长期效果。如果马蹄内翻足为特发性且在2岁前接受治疗，则患者符合本研究条件。回顾病历以获取年龄、性别、双侧性及手术治疗细节。后路松解术（1971年前实施）包括跟腱延长及后踝关节和距下关节松解。如卡罗尔所描述的综合松解术于1972年后实施。在最终复查时，患者完成庞塞蒂功能100分评分系统，接受检查并拍摄足部X线片。81例符合条件的患者中，59例（72%）接受了复查。两组患儿在手术时的年龄、性别及双侧性方面无显著差异。后路松解术组患者术后平均28年（范围25 - 30年）接受评估，综合松解术组患者术后平均16年（范围13 - 20年）接受评估。综合松解术组的庞塞蒂评分更高（平均86分对81分），但差异无统计学意义（p = 0.13）。与后路松解术组相比，综合松解术组每位患者所需的手术次数更少（1.5次对2.0次；p = 0.04）。两组的踝关节活动范围相似（p = 0.12），但后路松解术组距下关节僵硬患者的百分比更高（50%对18%；p = 0.01）。尽管基于功能加权的庞塞蒂量表两组无统计学差异，但综合组手术次数更少，足跟内翻矫正更完全，距下关节活动改善。
