儿童先天性马蹄内翻足肌力平衡术后继发外翻原因分析

Causes of secondary talipes valgus of congenital clubfoot post- operation in children

目的分析先天性马蹄内翻足肌力平衡术后继发外翻的原因并提出预防措施。方法对 23例 24足先天性马蹄内翻足肌力平衡术后继发外翻的原因进行分析。结果手术后继发外翻的主要原因包括肌力平衡术中解剖定位错误、转移肌腱附丽点选择不当，张力过大等。结论在彻底软组织松解、纠正畸形的同时，选择发育良好的肌肉、正确的肌腱附丽点位置 (第 3楔状骨为宜 )及合适的张力以建立有效的肌力平衡是预防肌力平衡术后继发外翻的关键。

Objective To analyze the causes of secondary talipes valgus of congenital clubfoot post- operation in children and describe the prophylactic measures.Methods According to the clinical features and findings during reoperation,23 patients with 24 feet were analyzed.Results Incorrect surgical technique,i.e.improper insertion or too high tension of the transplanted tendon was the main cause of secondary talipes valgus of congenital clubfoot post- operation.Conclusion The prerequisite for better results is to release the soft tissue and correct the deformities to the full extent and achieve a dynamic balance of the muscles.A well- developed transplanted muscle with correct insertion(e.g.the third cuneiform bone) and appropriate tension is emphasized.The patients should be followed- up regularly.Cases with poor results from the initial operation should be found out and re- operated on in time so as to obtain a satisfactory outcome.