先天性马蹄内翻足病因学研究

为先天性马蹄内翻足的神经肌肉病变学说提供科学依据。对手术后随访的９２例摄腰骶部Ｘ线片，７７例作直肠肛门测压检查，并对２３例患肢腓肠肌、胫前肌和腓骨肌４２个标本进行了运动神经支配的观察，测量了轴突终末支配比率，观察了运动终板形态，还通过琥珀酸脱氢酶组化染色检查了４８个标本不同肌群的组化分型变化。另外还对１４个标本进行了肌肉超微结构的研究。结果：９２例中发现７８．３％合并隐性能椎裂；肛管静息压和直肠肛管压差明显高于对照组；三组肌群中运动终板存在着退变或再生者占４２．９％～５４．６％；轴突终末支配比率（ＴＩＲ）增高者占６２％；组化分型提示有红肌纤维增高与集聚，肌纤维大小不等，形态各异，尤以腓肠肌和胫前肌突出，其超微结构也呈现去神经肌萎缩改变。这些改变提示本病病因系神经肌肉病变使三组肌力不平衡而产生马蹄内翻足，但是脊髓神经病变尚不清楚，肌肉改变是否为继发性病变也难定论。

An Etiolglcal Study on Congenital Clubfoot

To prove the neuro-muscular etiological theory of congenital clubfoot,lumbar-sacral X-ray films were taken in 92 cases of congenital clubfoot. Anorectal manometric test was performed on 77 patients. The studies of 42 specimens of tibialis anterior,gastrocnemius and peroneal muscles from 23 cases included(1)motor nerve inneration;(2)terminal innervation ratio(TIR)and(3)the features of motor end-plate. 48 biopoy spescimens from three groups of musclea, were examined histochemieally by succinate dehydrogenase stain and 14 were studied ultrastructurally,Among the 92 cases of clubfoot.72(78.3%)had spina bifida occulta,The anal-rectal pressure difference in these cases were higher than that in controls,The signs of nerve regenerative and regressive proceess of motor end plate were42.9%-54. 6%.TIR rose in 62%.The increasing,grouping and changing of red muscle fibers were obvious in the anterior tibialis and gastrocnemius.Denervated muscular atrophy was found by ultrastructural study. All these findings suggest that neuromuscular changes, play an important role in the pathogenes,is of clubfoot. It may give rise to imbalance of these, three groups of muscles, leading to talipes equinovarus. The pathological changes in the spinal cord remain unknown. It is still possible that all these findings are secondary affection.