后内侧软组织松解胫骨前肌半腱外移术治疗小儿先天性马蹄内翻足

TreatmentofCongenitalEquinovarusinChildrenwithPosterio-MedialSoftTissueReleaseandSplitAnteriarTibialTendonTransferGaoShulin,

自１９８６年起，作者对４８例（６２足）先天性马蹄内翻足采用了胫骨前肌半腱外移配合足后内侧软组织松解的治疗方法。通过平衡胫骨前肌的肌力，提高手术效果，避免第一跖骨下垂和外翻。在足后内侧软组织松解后，将胫骨前肌腱自止点分成两束，切断外侧束止点，将外侧半腱通过腱鞘内牵到胫前切口，再将此半腱通过小腿横韧带下送到足外侧切口，种植于骰骨上。本组获得随访４１例（４９足）其中４２足外形满意功能良好，占８５．７％，２足完全复发，无１例第一跖骨头下垂或足外翻。作者认为利用胫骨前肌半腱外移术平衡肌力取得了与胫骨前肌外移相似的疗效，又避免了第一跖骨头下垂和足外翻的发生，而且减少了小婴儿术中肌腱种植的困难。本文还讨论了畸形复发的原因，认为与手术后瘢痕和术中舟骨未完全复位有关。

Theauthorshadusedposterio-medialsofttissuereleaseandsplitanteriortibialtendontransplantationtothelateralsideofthefootforthetreatmentof48cases(62feet)ofcongenitalequino-varussince1986.Aftersofttissuerelease,thetendonoftibialisanteriorwascutintotwohalvesatitsinsertion,thelateralhalfwasthenpuledoutthroughintotheanteriartibialincisionanddrawnintothelateralincisionoverthefootthroughunderthetransversecruralligament.Thetendonwasimplantedintoatrapdoorinthecuboidbonewiththefootinneutralposition.41cases(49feet)werefolowed-up.47feetcured,therewerereurrencesin2feet.Splittransplantationoftheanteriortibialistendonlateralycannotonlybalancetheforceoftheanteriortibialis,withasimilarefectoftotaltransferofthetendon,butalsocanavoidthefalingofthefirstmetatarsalandexternalrotationofthefoot.Thelatertwoconditionswerenotseeninthisseries.