幼儿重型先天性马蹄内翻足一次性矫正疗效报道

Treatment of severe congenital equinovarus in children with the operation of one stage correction

目的 探讨幼儿重型先天性马蹄内翻足一次性矫正的方法及效果。方法 手术行跟腱延长,胫后肌腱延长,拇长及趾长屈肌腱延长,跖筋膜切断,胫前肌腱外置术,使肌力平衡;同时手法扳正,使跟骨、距骨、舟骨及骰骨等压缩,将畸形矫正成轻度外翻状,术后管形石膏固定3个月,结果 本组68例(99足),随访l～5年,平均27个月,马蹄内翻足完全矫正,效果优占72.7％,良占27.3％,无一例差。结论 后侧肌腱广泛松解、延长及手法矫正,可一次性矫正幼儿重型马蹄内翻足,并具有不损伤关节正常生理结构,远期关节功能良好,无关节僵硬及关节畸形等优点。

Objective To study the technique and therapeutic effect of one stage correction for severe congenital equinovarus in children. Methods The procedure included lengthening of achilles tendon, posterior tibialis tendon, flexor hallucis longus tendon and flexor digitorum longus tendon, cutting off fascia metatarsalia and spliting anterior tibial tendon transplantation to the lateral side of the foot for achieving dynamic muscle balance, then the deformity was correct- ed to a slightly valgus position by manipulated reduction and fixed with plaster cast for 3 months. Results There were 68 cases (99 feet) in this study. The mean follow - up time was 27 months ( 12 - 60 months) . All equinovarus achieved thoroughly correction. The outcome was showed that excellent in 72.7% cases, good in 27.3% , and no poor result. Conclusion Extensive and complete release of posterior soft tissue, lengthening and manipulated reduction can correct the deformity of equinovarus in one stage operation, without damaging the normal configuration of joint. The long - term results of joint function are good, with the advantages of no joint stiffness and deformity.