广泛软组织松解术治疗特发性马蹄内翻足

目的推荐应用广泛软组织松解术治疗特发性马蹄内翻足,以提高疗效。方法广泛软组织松解术治疗特发性马蹄内翻足16例17足,年龄8个月～4岁,平均23个月。15例单足,1例为双足。术后随访2个月～5年,平均随访时间为3年1个月。结果畸形完全纠正13足,占81．3％;畸形复发1足,占6．3％;皮缘坏死2足,占12．5％。结论广泛软组织松解术治疗特发性马蹄内翻足,跟骨、距骨、舟骨之间可充分旋转复位,从而使畸形得到较好的纠正。     

改良胫前肌外移软组织松解术治疗先天性马蹄内翻足

目的 :提高先天性马蹄内翻足的治疗效果。方法 :采用后路松解、改良胫前肌外移手术方法治疗 1岁 2个月～ 7岁儿童先天性马蹄内翻足 3 2例 ( 4 2足 ) ,按Garceau疗效评定标准对疗效进行评价。结果 :全部病例获随访 ,平均随访 1～ 5年 ,优 2 3例 ( 2 8足 ) ,良 8例 ( 13足 ) ,优良率 97%。结论 :软组织松解矫正畸形并改良胫前肌外移建立动态肌力平衡手术是治疗儿童先天性马蹄内翻足的有效方法     

距跟周围松解旋转术治疗儿童先天性马蹄内翻足

目的：探讨距跟周围松解旋转术治疗儿童先天性马蹄内翻足（CCF）的临床应用及近期疗效。方法：2004年至2006年采用距跟周围松解旋转术治疗儿童先天性马蹄内翻足24例（共36足）,术中行广泛的软组织松解、距跟去旋转矫正,保留跟距骨间韧带,去旋转绞链,避免跟骨失稳,行胫前肌腱延长。术后管型石膏固定6-8周。去除内固定后穿矫形支具〉1年。结果：均痊愈,平均随访2．3年（1～3年）,根据术后足的外观形态、足印、踝部功能、有无疼痛及x线检查评价疗效,疗效优16例25足;良6例8足;可2例3足,优良率为93．33％。结论：距跟周围松解旋转术是矫正儿童先天性马蹄内翻足的有效手术方法,其优点是手术松解充分、畸形纠正彻底,矫形效果良好。     

改良Hoke跟腱滑动延长术治疗先天性马蹄内翻足

[目的]推荐一种治疗先天性马蹄内翻足的手术方法和要点,以提高疗效。[方法]采用Hoke术滑动分离延长跟腱加距下关节后关节囊和(或)加踝关节后关节囊松解术治疗先天性马蹄内翻足,共48例76足。男30例,女18例,双侧28例,单侧20例;平均年龄7个月,最小年龄4个月,最大18个月。术后平均随访1年6个月,最短6个月,最长为3年。[结果]畸形完全纠正为66足占86.84%,畸形复发5足占6.94%,其他2足占2.77%。[结论]改良的Hoke跟腱滑动延长较好的纠正了马蹄,距下关节松解跟骨与距骨之间充分的旋转复位,而使马蹄畸形得到更好的纠正。此种手术方法矫形可靠,简单安全,疗效肯定。     

距骨下重建治疗先天性马蹄内翻足

距骨下重建治疗先天性马蹄内翻足李亚涛，谢怀春，罗伟，阿效诚１９９１年８月～１９９３年１０月，我院采用广泛松解，距下关节重建手术治疗先天性马蹄内翻足１４例（１８只足），取得较好疗效。现报道如下。１临床资料本组１４例１８只足，男１０例，女４例。年龄６～３...     

软组织松解治疗重度先天性马蹄内翻足

软组织松解治疗重度先天性马蹄内翻足刘明廷房清敏赵志彩毛宾尧＊自１９８３年７月至１９９０年８月，我院共收治重度先天性马蹄内翻足３７例，４２足。采取软组织松解方法，较大儿童辅以骨性手术。经５～１０年随访，疗效可靠、稳定。１临床资料本组男２５例、女１２例，...     

重度马蹄内翻足畸形38例治疗体会

重度马蹄内翻足畸形３８例治疗体会李开贤，罗桂英，杨墨松自１９８３～１９９３年，我们共收治重度马蹄内翻足畸形３８例。其中儿麻后遗症１７例，先天性马蹄内翻足２１例。采用软组织松解术、石膏固定及骨性矫形术相结合，多次矫正的方法，达到治疗目的。近期随访，治疗...     

改良Ponseti方法治疗先天性马蹄内翻足疗效

[目的]评价改良Ponseti方法治疗先天性马蹄内翻足疗效.[方法]在Ponseti方法(连续石膏矫形加经皮跟腱切断加足外展矫形支具)的基础上稍加改良,并应用于治疗先天性马蹄内翻足76例116足,男52例80足,女24例36足;年龄5 d～4岁.[结果]本组病例76例均得到随访,平均随访25.5个月,最长46个月,按Dimeglio评分分级方法,76例116足中73例112足(96.5%)畸形矫正满意.[结论]改良Ponseti方法对4岁以内的婴幼儿先天性马蹄内翻足均可取得满意的效果.     

Ilizarov技术联合经皮切腱术治疗儿童复发性先天性僵硬型马蹄内翻足

目的 评估Ilizarov改良足踝构型治疗儿童复发性先天性僵硬型马蹄内翻足的疗效.方法 2012年6月至2018年9月河南省儿童医院郑州儿童医院骨科应用Ilizarov技术治疗儿童复发性先天性僵硬型马蹄内翻足25例37足,男21例,女4例;年龄3岁4个月～12岁,平均(7.22±2.2)岁;左侧7例,右侧6例,双侧12...     

手术矫正先天性马蹄内翻足的疗效分析

目的：探讨先天性马蹄内翻足采用手术后路松解为主，结合石膏矫形远期疗效评价。方法：应用专家设计的手术后路松解为主，结合石膏矫形的治疗先天性马蹄内翻足本组18例，后路松解扩大踝穴，距骨复位是该手术的关键。结果；经术后5年6个月的随访，平均年龄6．7岁，从形态功能发育情况综合评价，优8足，良6足，可3足，优良率84．25％。结论：“动静”结合的管型石膏软组织后路松解为主是治疗先天性马蹄内翻足的根本原则，经术后随访及统计学分析，该方法是合理有效的。     

Comparison of posteromedial and subtalar release in surgical treatment of resistant clubfoot

This preliminary study evalluated two surgical techniques for the treatment of resistant clubfoot: the posteromedial and the subtalar release. Two groups of matched patients with idiopathic clubfoot who underwent surgery between 1983 and 1995 were compared. In group 1 (12 patients, 18 feet), posteromedial release was performed. In this group, the results were satisfactory with a tendency to hypocorrection: 4 (22%) feet needed a secondary procedure (average follow-up: 97.8 months). Group 2 (12 patients, 17 feet) underwent complete subtalar release. The results were clinically better for group 2 (average follow-up: 38.8 months). Only 1 (5.9%) patient needed a secondary procedure. These results suggest complete subtalar release yields better postoperative correction than posteromedial release.     

Follow up of complete subtalar release for clubfoot—Evolution of different scores

BackgroundEven today there are still some cases of clubfoot that require a more extensive form of treatment. Thus, it is still essential to ascertain the development of the clubfoot after extensive release operations.Method70 children presenting 99 cases of primary clubfoot (age 8 months–10 years) were followed up after 4.5 and 9 years following complete subtalar release. Function, clinical and radiological results as well as 3 scores were assessed at both dates.ResultsFunction and pain worsened between the two follow-up periods, whereas objective clinical and radiological results remained equivalent. 44–79% were rated good or excellent depending on the scoring system applied.Older children with primary clubfoot had comparable results to children operated on at a younger age; also pre-operated feet achieved similar results.ConclusionIn our opinion the results justify keeping complete release in mind as an alternative method in cases of severe residual and recurrent clubfoot.     

Results of surgical correction of congenital talipes equinovarus]

Different surgical procedures in the treatment of clubfoot were analyzed, especially in correlation to over-correction and inadequate correction. Indications for surgery, surgical errors and their influence on outcome were assessed. 82 children (28 females and 54 males) with 130 congenital equinovarus underwent surgery between 1988 and 1994. Age at the time of operation ranged from 6 to 13 months (average: 9 months). Posterior release (i.e. partial subtalar release) was conducted in 68 cases of clubfeet and complete subtalar release in 62 cases. During follow-up 44 children with 64 clubfeet were reviewed. Magone's criteria were used to assess final results. 15 (23%) feet showed very good results, 26 (41%)--good results, 14 (22%)--satisfactory and 9 (14%)--poor or no correction.     

Fibular shortening in clubfeet

Seventy-eight children (105 feet) operated on for congenital clubfoot with two different procedures - limited posteromedial-lateral release and complete subtalar release - were analysed. For all of them the age at operation ranged from 3 to 76 months (mean 17 months) and follow-up from 41 to 84 months (mean 58 months). The control group consisted of 42 opposite feet from the patients with a unilateral deformity. In all the feet operated on, a higher positioning of the fibula in relation to the talar dome was found. A correlation between the high positioning of the fibula and the strength of the plantar flexors was noted in children operated on by limited posteromedial-lateral release (the weaker the strength of the plantar flexors the higher the position of the fibula in the ankle). There was no correlation between the position of the fibula and the hindfoot valgus, the limited range of motion within the talo-calcaneo-navicular joint, and the talo-calcaneal angle in the anteroposterior view. In the same group, the difference in the distance between lateral malleolus and talar dome in the healthy and affected foot did not increase with age, but in the group operated on by complete subtalar release, there was a tendency for increasing shortening.     

Comparison of the soft-tissue release methods in idiopathic clubfoot

The aim of this study was to compare the clinical and radiologic results of three different surgical procedures (posterior release with lengthening of the tendo calcaneus and posterior capsulotomy, Turco's technique of posteromedial release, and Simons' technique of complete subtalar release) in idiopathic clubfoot in 77 patients who were operated on at 10 months of age or younger. The clinical examination alone is not sufficient to determine the type of the surgical intervention needed in idiopathic clubfoot; the decision must be supported by the radiologic parameters (anteroposterior and lateral talocalcaneal, first metatarsal-talar, and lateral tibiotalar angles) and all the components of the multiplanar deformity must be corrected at the same time. Simons' technique of complete subtalar release was found to be the most efficient method of surgery both functionally and radiologically in cases of idiopathic clubfoot in infants. The overcorrection of the deformity as a consequence of the concern that the tarsal alignment did not improve adequately is a mistake we make not infrequently and in our opinion this may be avoided by taking perioperative radiographs.     

Predictive value of intraoperative clubfoot radiographs on revision rates

The predictive value of intraoperative radiographic assessment and its correlation with short term revision rates is presented for surgical correction of resistant clubfoot. Seventy-three children (115 feet) who underwent a primary procedure at one institution for idiopathic clubfoot between January 1991 and December 1994 were reviewed. A strategy using sequential release guided by intraoperative radiographs was employed in all cases. The intraoperative radiographic findings correlated with the need for early revision surgery, with residual radiographic evidence of cavus deformity associated with the greatest risk for revision. The sequential release strategy resulted in fewer overcorrections compared with historical controls of more complete subtalar release.     

Evaluation of pathologic abnormalities of clubfoot by magnetic resonance imaging

Three-dimensional analyses of clubfoot in infants younger than 1 year of age were done using magnetic resonance imaging in an in vivo study. Twenty-one patients (31 feet) with congenital clubfoot were examined. The average age at examination was 8.6 months (range, 4-12 months). All patients originally were treated using corrective casts. Seventeen feet required complete subtalar release operations and the remaining 14 feet were treated conservatively with various orthoses. Four measurements using magnetic resonance imaging were performed in the transverse and coronal planes as follows: the calcaneus adduction angle, to define the degree of medial rotation of the calcaneus in the transverse plane; the navicular angle, to define the degree of medial displacement of the navicular; the talus neck angle, to define the degree of medial angulation of the talus; and the calcaneus shift index, to define the degree of medial shift of the calcaneus beneath the talar head in the coronal plane. In the results, all four measurements of clubfoot on magnetic resonance imaging were statistically different from those of normal feet. In the surgical group there were statistical differences in the calcaneus adduction angle, the navicular angle, and the calcaneus shift index (including two feet of patients whose parents had rejected proposed treatment), compared with the conservative group, but there was no statistical difference in the talus neck angle. Magnetic resonance imaging could delineate the three-dimensional abnormalities of the tarsal bones in clubfoot and quantitatively evaluate the severity of clubfoot.     

Clubfoot surgical treatment: preliminary results of a prospective comparative study of two techniques.

Twenty patients with 30 idiopathic resistant clubfeet were operated on by the same surgeon. The mean patient age was 7.7 months (range, 3.5-19 months). Two different surgical techniques (15 posteromedial release and 15 complete circumferential subtalar release) were used during a prospective randomized study. Average follow-up was 2 years 3 months. None of the children had received previous conservative treatment. Radiologic assessment on lateral and anteroposterior radiographs included preoperative and follow-up measurements of tibiotalar, tibiocalcaneal, talocalcaneal, talo-I meta, and calcaneo-V meta angles, as well as physis morphology, talocalcaneal divergence, and location of the navicular. Before surgery, both groups were statistically similar as assessed by the Student t test. Follow-up results were also statistically similar between the groups. Functional assessment, according to Magone's score, showed global average excellent and good results in 23 feet (76.7%), with a slight but not significant difference (P = 0.77) between the two techniques. At short-term follow-up, no significant differences were found in radiologic and functional results between the two surgical procedures for idiopathic clubfoot.     

Correlation of foot radiographs with foot function as analyzed by plantar pressure distribution

The goal of this study was to correlate radiographic measurements to the dynamic plantar pressure of the residual clubfoot. This was done by comparing radiographs and EMED plantar pressure results in 61 idiopathic clubfeet in 39 children at an average of 8 years after complete subtalar release. Radiographic measures were obtained using the standard method outlined by Simons, and pressure data were collected for eight regions of the foot. Pearson correlation analysis was performed and the most significant correlation was found between the calcaneal/first metatarsal angle in the lateral radiographic view (r = 0.72) and the midfoot contact area. In the anteroposterior view there was mild correlation between the talus/first metatarsal angle and both the peak pressure and plantar contact area. The results of this study indicate that radiographs used in concert with dynamic plantar pressure analysis will provide a more complete assessment of the corrected clubfoot.