先天性马蹄内翻足联合手术长期疗效观察

[目的]观察联合手术治疗小儿先天性马蹄内翻足的远期疗效.[方法]对102例先天性马蹄内翻足患儿,采用跟腱切断、足内侧软组织松解、跖筋膜切断、胫前肌外移等联合术式,并管型石膏外固定治疗.[结果]经5～13年随访,平均随访9.8年,按Garceau的标准进行评价,优良率97.1%.[结论]联合手术治疗小儿先天性马蹄内翻足疗效确切,效果满意.     

先天性马蹄内翻足不同年龄外科治疗

目的：探讨不同年龄组先天性马蹄内翻足手术方法和疗效。方法：采用多种术式治疗先天性马蹄内翻足352例（389足）,结果：302例（326足）经2－8年随访,总优良率95．40％,结论：先天性马蹄内翻足的外科治疗,应根据其年龄大小,足畸形程序特点,综合选择术式即挛缩软组织松解,建立动态平衡,骨性手术可取得满意效果。     

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     

肌腱转移手术治疗55例幼儿先天性马蹄内翻足效果随访

[目的]探讨幼儿先天性马蹄内翻足的手术治疗效果。[方法]对55例(83足)先天性马蹄内翻足,采用跟腱延长 胫前或胫后肌外移手术。[结果]55例均获随访,随访时间平均6.5年,按HuangYT标准:优62足,良17足,可4足。优良率95.2%。[结论]早期手术建立动态肌力平衡是治疗儿先天性马蹄内翻足的有效方法,随着年龄的增长可矫正畸形,取得外观和功能满意的疗效。     

可调节支具在婴幼儿先天性马蹄内翻足治疗中的应用研究

[目的]探讨可调节支具治疗婴幼儿先天性马蹄内翻足的应用方法及效果。[方法]2014年1月~2016年2月在本科治疗的先天性马蹄内翻足患儿60例(96足),随机分为支具组30例(50足)和石膏组30例(46足),支具组采用ponseti手法矫形结合可调节支具治疗,石膏组采用典型Ponseti方法治疗,比较两组患者的临床疗效。[结果]所有患儿平均随访时间(13.4±3.5)个月,治疗后患足外观与功能均得到明显改善,支具组与石膏组Dimeglio评分分级及优良率比较差异无统计学意义(P>0.05)。[结论]可调节支具治疗婴幼儿先天性马蹄内翻足近期疗效明确,远期疗效尚待进一步研究。     

小儿马蹄内翻足的不同病理特点和治疗

作者分析先天性、麻痹性和痉挛性马蹄内翻足不同病理特点,采用不同治疗方案治疗马蹄内翻足76例108足,随访8个月～7年,优良率为89.3％。对先天性马蹄内翻足,其治疗重点是彻底松解,平衡肌力和矫正骨畸形。对麻痹性下垂内翻足,重点是平衡肌力,而对痉挛性马蹄内翻足,肌力平衡不等于痉挛平衡,最好先行降低肌张力和痉挛的SPR手术,否则在行肌力平衡的同时尽量使紧张性痉挛得到平衡或使其缓解。     

应用Ponseti方法治疗大龄儿先天性马蹄内翻足

1 先天性马蹄内翻足治疗方法的历史回顾 先天性马蹄内翻足(congenital talipes equinovarus或congenital clubfoot)是一种常见的出生缺陷和儿童骨关节畸形,由足内翻、踝跖屈、前足内收3种主要畸形因素组成,是骨科领域内常见的、需要特别治疗的先天性畸形[1].据世界卫生组织(WHO)有关资料显示,全球每年有近20万的新生儿患有马蹄内翻足,其中80%在亚洲等发展中国家.中国是最大的发展中国家,也是出生缺陷的高发国家之一,估计每年约有7万的新生儿患有先天性马蹄内翻足[1].     

Ponseti法治疗先天性马蹄内翻足中期随访疗效分析

目的分析Ponseti法治疗先天性马蹄内翻足的中期随访疗效。方法对38例(42足)先天性马蹄内翻足采用Ponseti法治疗,先行手法矫正畸形,长腿管型石膏外固定矫正前足内收、中足高弓、后足内翻,再行经皮跟腱切断术,最后佩戴矫形支具。结果本组均获随访9~62个月,平均38个月。末次随访时按Dimglio评分系统进行评分:TypeⅠ型(包括恢复正常者)35例(37足),TypeⅡa型(轻度)2例(3足);TypeⅡb型(中度)1例(2足)。结论采用Ponseti法治疗先天性马蹄内翻足效果满意,但矫正的手法要求较高。     

早期保守治疗先天性马蹄内翻足疗效分析

目的 :讨论早期保守治疗先天性马蹄内翻足疗效。方法 :收集 1997年 2月～ 2 0 0 2年 12月 ,采用早期持续被动活动、手法按摩矫正、矫形石膏夹板矫正、白天穿外厚内薄的硬筒靴、夜间应用DennisBrowne夹板等综合手法治疗先天性马蹄内翻足 86例 ,其中新生儿期 3 2例、小婴儿期 3 4例、大婴儿期 2 0例 ;轻度 3 8例、中度 3 5例、重度 13例。结果 :经术后 1～ 5年随访 ,从形态功能发育情况综合评价 ,优良率 :新生儿期 93 8% ;小婴儿期82 4% ;大婴儿期 5 5 0 % ;轻度 94 7% ;中度 71 4% ;重度 46 2 %。结论 :保守治疗先天性马蹄内翻足的疗效与治疗的时间、术前的畸形程度有关 ,≤ 6个月的轻、中度先天性马蹄内翻足早期保守治疗效果好 ,重度部分有效     

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，...     

Electric excitability of the peroneal muscles in congenital equinovarus deformity

Irritability of the peroneal muscles by stimuli of the rectangular current in infants with congenital club foot was examined. Examinations were performed immediately before surgery in patients in general Ketamine anesthesia. The first group contained children with unilateral congenital club foot and the normal extremity was examined for comparison. In the group of children with bilateral club foot, one of the feet was examined twice about 4 months apart. A decrease of irritability of the peroneal muscles was found before operation. After operation this irritability reached the proper values. The authors think that the peroneal muscles in congenital club foot are stretched and that after correction of deformation their length and tension become normal.     

The treatment of congenital club foot by operation to correct deformity and achieve dynamic muscle balance.

We operated on 111 patients with 159 congenital club feet with the aim of correcting the deformity and achieving dynamic muscle balance. Clinical and biomechanical assessment was undertaken at least six years after operation when the patient was more than 13 years of age. The mean follow-up was for 11 years 10 months (6 to 36 years). Good and excellent results were obtained in 91.8%. Patients with normal function of the calf had a better outcome than those with weak calf muscles. The radiological changes were assessed in relation to the clinical outcome. The distribution of pressure under the foot was measured for biomechanical assessment. Our results support the view that muscle imbalance is an aetiological factor in club foot. Early surgery seems to be preferable. It is suggested that operation should be undertaken as soon as possible after the age of six months, although it may be carried out up to the age of five years. The establishment of dynamic muscle balance appears to be an effective method of maintaining correction. Satisfactory long-term results can be achieved with adequate appearance and function.     

Features Resisting Primary Treatment of Congenital Club Foot

The aims of this study were: (1) to see whether the number of relapses of hindfoot deformity in congenital club foot in the first year of life could be reduced by operative treatment, and (2) to try by surgery to pinpoint features of congenital club feet that make them resistant to treatment.

As compared to treatment of 95 feet with manipulation and plaster casts only or with heel cord tenotomy added, early tenotomy of both the heel cord and the tibialis posterior tendon in 23 feet markedly reduced the number of relapses of hindfoot deformity, and the need for additional treatment. The results indicate that the achilles and the tibialis posterior tendons, and their corresponding muscles, are the main dynamic features that need to be dealt with when treating the hindfoot deformity in congenital club foot.     

Features Resisting Primary Treatment of Congenital Club Foot

The aims of this study were: (1) to see whether the number of relapses of hindfoot deformity in congenital club foot in the first year of life could be reduced by operative treatment, and (2) to try by surgery to pinpoint features of congenital club feet that make them resistant to treatment.

As compared to treatment of 95 feet with manipulation and plaster casts only or with heel cord tenotomy added, early tenotomy of both the heel cord and the tibialis posterior tendon in 23 feet markedly reduced the number of relapses of hindfoot deformity, and the need for additional treatment. The results indicate that the achilles and the tibialis posterior tendons, and their corresponding muscles, are the main dynamic features that need to be dealt with when treating the hindfoot deformity in congenital club foot.     

Correction of neglected idiopathic club foot by the Ponseti method

The Ponseti method of treating club foot has been shown to be effective in children up to two years of age. However, it is not known whether it is successful in older children. We retrospectively reviewed 17 children (24 feet) with congenital idiopathic club foot who presented after walking age and had undergone no previous treatment. All were treated by the method described by Ponseti, with minor modifications. The mean age at presentation was 3.9 years (1.2 to 9.0) and the mean follow-up was for 3.1 years (2.1 to 5.6). The mean time of immobilisation in a cast was 3.9 months (1.5 to 6.0). A painless plantigrade foot was obtained in 16 feet without the need for extensive soft-tissue release and/or bony procedures. Four patients (7 feet) had recurrent equinus which required a second tenotomy. Failure was observed in five patients (8 feet) who required a posterior release for full correction of the equinus deformity. We conclude that the Ponseti method is a safe, effective and low-cost treatment for neglected idiopathic club foot presenting after walking age.     

Surgical treatment of congenital clubfoot in children

The paper is based on the author's personal experience in the surgical treatment of 438 patients with congenital club foot aged from 9 months to 9 years. Peritalar ligamentocapsulotomy according to the author's method gave good long-term results in 82.64% of the children, satisfactory results in 12.83% and not satisfactory results in 4.53% of the patients. The results were studied within 2 to 20 years after the operation and evaluated according to the clinicoroentgenologic findings. Distinguished among the causes of the recurrences have been violations of the orthopaedic regime, reduction in the function of the extensor muscles and pronators and disturbances in the development of the bones of the medial part of the foot. Dissection of the plantar aponeurosis was not performed in any patient. Dislocation of the tendon attachment area on the foot may be advised for the children threatened by a recurrence of club foot of the anterior part of the foot and in passive complete correction of the foot.     

Rehabilitative therapy after correction of congenital clubfoot in children]

There have been analysed 49 children with congenital club foot (79 feet). All patients before arrival were treated according to the common methods and 42 children (64 articulations) were subjected to operative or apparatus-made correction of the club foot recurrence. In spite of the treatment obtained all children arrived with the residual signs of club foot. There are described the mechanisms of the club foot recurrence development, proposed a method of stage-by-stage redressment, needle and manual therapy realization.     

MRI study of talonavicular alignment in club foot

We studied in vivo the talonavicular alignment of club foot in infants using MRI. We examined 26 patients (36 feet) with congenital club foot. The mean age at examination was 9.0 months (4 to 12). All analyses used MRI of the earliest cartilaginous development of the tarsal bones in the transverse plane, rather than the ossific nucleus. The difference in the mean talar neck angle (44.0 +/- 8.1 degrees) in club foot was statistically significant (p < 0.001) when compared with that of the normal foot (30.8 +/- 5.5 degrees). The difference between the mean angles in the group treated by operation (47.9 +/- 6.7 degrees) and those treated conservatively (40.1 +/- 7.5 degrees) was also statistically significant. The anatomical relationship between the head of the talus and the navicular was divided into two patterns, based on the position of the mid-point of the navicular related to the long axis of the head. In the operative group, 18 feet were classified as having a medial shift of the navicular and none had a lateral shift. In the conservative group, 12 showed a medial shift of the navicular and six a lateral shift. All nine unaffected normal feet in which satisfactory MRI measurements were made showed a lateral shift of the navicular. Club feet had a larger talar neck angle and a more medially deviated navicular when compared with normal feet. This was more marked in the surgical group than in the conservative group.     

Causes of recurrence of congenital clubfoot in children and indications for surgical treatment

Unsatisfactory results of the conservative treatment of club foot deformity in 220 patients (346 feet) were analyzed. Data of roentgenograms in 86 patients enabled the authors to make a conclusion that an early cause of recurrent club foot is the delayed formation of nuclei of ossification of the navicular and I sphenoid bones, the later cause of the recurrent deformity is early synostosis of the epiphysis of the metatarsal bone. The importance of dispensary observation ad prophylactic measures after the treatment of congenital club foot is emphasized.