Morita S, Muneta T, Yamamoto H, Shinomiya K
Division of Rehabilitation Medicine, Tokyo Medical and Dental University, Japan.
Clin Orthop Relat Res. 1998 May(350):166-73.
Surgical correction was performed on 125 patients who had equinovarus deformity caused by a cerebrovascular accident and who needed an ankle foot orthosis for walking. The operative procedures involved anterior transfer of the long toe flexors (flexor hallux longus and flexor digitorum longus; long toe flexor group) or lateral transfer of the anterior tibial tendon (anterior tibial tendon group), combined with lengthening of the Achilles tendon. On evaluation more than 2 years after surgery, 83 of 110 patients of the long toe flexor group and eight of 15 patients of the anterior tibial tendon group were able to walk without a brace. Five patients of the anterior tibial tendon group who had shown strong contraction of the anterior tibial muscle during the swing phase before surgery, needed a brace because of a drop foot after surgery. Thus, lateral transfer of the anterior tibial tendon was abandoned in 1984. Recurrence of varus deformity was seen in approximately 15% of the patients in both groups. Anterior transfer of the long toe flexors, using them as dorsiflexor tendons or for tenodesis, seemed to produce better results.
对125例因脑血管意外导致马蹄内翻畸形且行走需要踝足矫形器的患者进行了手术矫正。手术操作包括长趾屈肌（拇长屈肌和趾长屈肌；长趾屈肌群）向前移位或胫骨前肌腱（胫骨前肌腱组）向外侧移位，并结合跟腱延长术。术后2年以上进行评估时，长趾屈肌群110例患者中有83例、胫骨前肌腱组15例患者中有8例能够不借助支具行走。胫骨前肌腱组中有5例患者在术前摆动期胫骨前肌出现强烈收缩，术后因足下垂而需要支具。因此，1984年放弃了胫骨前肌腱向外侧移位的手术方式。两组中约15%的患者出现内翻畸形复发。将长趾屈肌向前移位，用作背屈肌腱或进行腱固定术，似乎能产生更好的效果。
