Chang C H, Huang S C
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 1998 May;97(5):328-34.
Clubfoot deformity associated with congenital constriction band syndrome (CCBS) has different characteristics than classic idiopathic clubfoot, and is more difficult to treat. We describe the manifestations, treatment, and outcomes of nine patients treated for 11 CCBS-associated clubfoot deformities between 1980 and 1993. All but one of these children had an abnormal gestational or neonatal history. From an assessment of the correctability of the deformity and the associated secondary changes, the clubfoot severities were all classified as grade B (intermediate). The constriction bands in eight clubfeet were classified as type 0 (5 feet), II (2), or III (1), according to the location and depth of the band. Band types in three feet were unclassified because the band release was performed at other hospitals. We released the bands before correcting the clubfeet in the two patients with type II bands. The five patients with type 0 bands received casting first but with poor response. All clubfeet were corrected surgically; the procedures were posteromedial release in 10 feet, split tibialis anterior tendon transfer in five, and lengthening of the Achilles tendon in three. At an average follow-up of 3.8 years, seven of the 11 clubfeet were classified as having good results and four as fair. Among the six clubfeet with constriction bands on the ipsilateral leg, five were classified as having good results and one as fair. Two of the five clubfeet without constriction bands on the ipsilateral leg had good results and three had fair results. The presence of a band did not influence the final outcome of the clubfoot deformity (p > 0.05). In the five patients with forefoot varus deformity due to peroneal weakness, tibialis anterior tendon transfer successfully corrected the deformity. All the clubfeet treated in this series were plantigrade after treatment and had satisfactory results.
与先天性束带综合征（CCBS）相关的马蹄内翻足畸形具有与典型特发性马蹄内翻足不同的特征，且治疗难度更大。我们描述了1980年至1993年间9例因11处与CCBS相关的马蹄内翻足畸形接受治疗的患者的临床表现、治疗方法及结果。除1名儿童外，所有这些儿童都有异常的妊娠或新生儿病史。根据畸形的可矫正性及相关继发改变评估，所有马蹄内翻足严重程度均分类为B级（中度）。根据束带的位置和深度，8例马蹄内翻足的束带分类为0型（5足）、II型（2足）或III型（1足）。3足的束带类型未分类，因为束带松解术是在其他医院进行的。在2例II型束带患者中，我们在矫正马蹄内翻足之前先松解了束带。5例0型束带患者首先接受了石膏固定，但效果不佳。所有马蹄内翻足均接受了手术矫正；手术方式包括10足行后内侧松解术、5足行胫前肌腱劈开转移术、3足行跟腱延长术。平均随访3.8年时，11例马蹄内翻足中有7例结果为良好，4例为一般。在同侧腿部有束带的6例马蹄内翻足中，5例结果为良好，1例为一般。同侧腿部无束带的5例马蹄内翻足中，2例结果为良好，3例为一般。束带的存在并不影响马蹄内翻足畸形的最终结果（p>0.05）。在5例因腓骨肌无力导致前足内翻畸形的患者中，胫前肌腱转移术成功矫正了畸形。本系列治疗的所有马蹄内翻足治疗后均为平足，结果满意。
