皮下跟腱切断术在Ponseti方法治疗先天性马蹄内翻足中的作用

Importance of percutaneous tendoachilles tenotomy in Ponseti method

[目的]介绍皮下跟腱切断术的手术指征、方法,阐明皮下跟腱切断术在Ponseti方法治疗先天性马蹄内翻足中的重要性。[方法]本院自2000年1月~2005年12月,采用Ponseti方法治疗先天性马蹄内翻足236例,男196例,女40例,共330足,年龄3 d^13个月。选择连续矫形石膏后,足不能背屈>15°,不能保持外展70°位置的病例为施行皮下跟腱切断术指征。308足具备手术指征接受手术治疗,22足未行皮下跟腱切断术而直接佩戴矫形支具。[结果]佩戴支具后定期随访,平均随访期2.1年,随访率97.88%。所有行手术的跟腱无1例不连接,外观连续,扪之有弹性,已行走者步态正常,跟腱有力。随访中,未手术组4足出现马蹄复发,行皮下跟腱切断术;手术组31足出现不同程度的马蹄,内收畸形复发,再行皮下或切开跟腱延长术及肌腱转移术。所有接受手术者无1例出现“摇椅足”畸形。[结论]皮下跟腱切断术是Ponseti方法治疗先天性马蹄内翻足中非常重要的环节,是完全矫正马蹄畸形的关键,它对于恢复跟骨的解剖位置,维持足正常的形态具有重要意义。严格把握手术指征,仔细操作,正确配合矫形石膏和外展支具使用,有助于取得Ponseti方法治疗的成功。

[ Objective] To introduce the indication and method of percuaneous tendoachilles tenotomy and discuss its importance in Ponseti method. [Method] 236 case 330 feet （male 196 and female 40, age from 3 days to 13 months） were managed with Ponseti method in this hospital from Jan. of 2000 to Dec. of 2005. A percutaneous tendoachilles tenotomy was performed on 308 clubfeet when less than 15° of ankle dorsiflexion and 70° of foot abduction. 22 feet treated with foot - abduction brace directly. [Result] 330 feet were followed in 325 feet with a mean time of 2. 1 years. The tendon performed tenotomy were all connected and patients walk with normal gait later. 4 feet in none - surgery group and 31 feet in surgery group were referred for further surgery because of the reoccured deformity. None Rocker - bottom foot happened. [ Conclusion ] Percutaneous ten- doachilles tenotomy is very important in Ponseti method which is the key to totally correct the equines deformity. Combined with well - molded long - leg plaster casts and foot - abduction brace properly will always achieve a successful result.