先天性马蹄内翻足经皮跟腱切断手术时机的选择

The timing of percutaneous Achilles tenotomy in Ponseti method treating of congenital clubfoot

目的应用Ponseti方法早期治疗先天性马蹄内翻足(先天性马蹄内翻足),探讨经皮跟腱切断手术时机的选择。方法60例(91足)先天性马蹄内翻足患儿,随机分为A、B两组,每组30例,治疗初评分≥4分(僵硬型)。A组患足矫形外展至70°、背屈<15°、同时HS>1、MS<1和距骨被覆盖;B组患足矫形至前足内收纠正但无法背屈,同时HS>1、MS≤1,行跟腱切断术;以Pirani评分标准比较两组治疗结果。结果患儿均得到随访,时间6～30(15±5)个月。A、B两组手术前石膏矫形次数分别为(5.1±0.91)次、(2.42±0.56)次(P<0.05),治疗时间分别为(36.8±4.98)d、(19.3±5.09)d(P<0.01),差异有统计学意义。两组跟腱均获得愈合,跖屈有力,术后患足背屈活动度差异无统计学意义(P>0.05)。结论在Ponseti方法矫正僵硬型马蹄足过程中,畸形愈严重跟腱挛缩愈严重,早期行经皮跟腱切断手术可明显减少石膏矫形次数、缩短疗程,不影响疗效。

Objective To evaluate the timing of Achilles＇s tenotomy in correction the deformity of the congenital clubfoot using the Ponseti method.Methods 60 patients（91 clubfeet） were randomized into two groups.Group A：（30 patients,46 clubfeet） were undergone percutaneous tenotomy of the Achilles tendon after 4～6 cast correction,when the foot dorsiflexion could not arrive 15° and abduction 70° with HS〉1,MS〈1.Group B：30 patients（45 feet） had their percutaneous tenotomy of the Achilles tendon after 2～3 casts correction with HS〉1,MS≤1.All feet were scored using the Pirani method at presentation and at each subsequent attendance.Results All cases were followed up for 6～30（15±5） months.The duration of correction were full correction was obtained in 90（99%） clubfeet.Group A required an average of 5.1±0.91 casts（range 4 to 10）,compared to 2.42±0.56 casts（range 2 to 5） in Group B（P〈0.01）.Average time for correction was（36.8±4.98）d and（19.3±5.09）d（P〈0.01）in Group A and B.Two groups of Achilles tendon were restored a poweful planter flexion,dorsifexion activity with no significant differenct（P〉0.05）.Conclusions Performing the Achilles tenotomy just after the talonavicularis reduced is applied significantly decreases the number of casts required for correction and shortens the length of treatment.