Wang Ningqing,Hu Xinyong,Liu Zhenjiang,et al.Preliminary outcomes of tibialis anterior transfer to the peroneus tertius combined with post-operative weight-bearing cast immobilization in children with acquired equinovarus foot[J].Journal of Clinical Pediatric Surgery,2025,(06):559-564.[doi:10.3760/cma.j.cn101785-202504067-010]
胫前肌转移至第三腓骨肌结合术后负重行走石膏治疗儿童后天性马蹄内翻足的初步疗效
- Title:
- Preliminary outcomes of tibialis anterior transfer to the peroneus tertius combined with post-operative weight-bearing cast immobilization in children with acquired equinovarus foot
- 摘要:
- 目的 初步探讨胫前肌转移至第三腓骨肌结合术后负重行走石膏治疗儿童后天性马蹄内翻足的临床疗效。方法 回顾性分析2018年8月至2023年11月首都医科大学附属首都儿童医学中心骨科完成的25例采用胫前肌转移至第三腓骨肌结合术后负重行走石膏治疗的儿童后天性马蹄内翻足患儿临床资料。男17例,女8例。手术时年龄最大15岁7个月,最小3岁3个月,平均年龄9岁。左足9例,右足7例,双足9例。25例患儿(共34足)术后随访6~30个月(平均18个月)。统计分析原发病因、手术方式及术后并发症情况,术前及末次随访时均采用美国矫形足踝协会(American Orthopedic Foot & Ankle Society,AOFAS)踝-后足评分系统评价足踝部外观及功能。结果 原发病因:脑瘫11例(11/25,44%),脊髓栓系综合征2例(2/25,8%),黏多糖贮积症1例(1/25,4%),肌营养不良1例(1/25,4%),遗传性运动和感觉神经系统疾病1例(1/25,4%),其他不明原因9例(9/25,36%)。实施手术情况依次为:胫前肌外移术100%(34/34),跟腱延长术85.3%(29/34),跖筋膜部分松解术73.5%(25/34),腓肠肌腱膜松解术14.7%(5/34),1/2胫后肌腱外移术11.8%(4/34),拇长伸肌腱1/2后移术8.8%(3/34),第一跖骨基底V形截骨克氏针固定术5.9%(2/34)。患儿术后均采用石膏固定。伤口均愈合,无一例发生感染。复发1例,复发率2.9%(1/34)。末次随访时踝-后足AOFAS评分为(91.88±4.06)分,与术前的(58.84±3.07)分比较,差异有统计学意义(t=38.895,P＜0.001)。末次随访时踝-后足AOFAS评分优20例(20/25,80%),良4例(4/25,16%),可1例(1/25,4%)。结论 胫前肌转移至第三腓骨肌结合术后负重行走石膏固定治疗儿童后天性马蹄内翻足,可在短期内有效改善足踝功能评分,且并发症发生率低。
- Abstract:
- Objective To evaluate the short-term clinical efficacy of transferring the tibialis anterior tendon to the peroneus tertius combined with post-operative weight-bearing walking cast in children with acquired equinovarus foot in children. Methods A retrospective review was performed of 25 children with acquired equinovarus foot who underwent tibialis anterior transfer to the peroneus tertius followed by weight-bearing walking-cast immobilization in the Department of Orthopedics,Capital Center for Children’s Health,Capital Medical University,between August 2018 and November 2023.The cohort comprised 17 boys and 8 girls;age at surgery ranged from 3 years 3 months to 15 years 7 months (mean,9 years).The deformity involved the left foot in 9 cases,the right foot in 7 cases,and both feet in 9 cases,for a total of 34 feet.Post-operative follow-up ranged from 6 to 30 months (mean,18 months).Primary etiologies,surgical procedures,and post-operative complications were recorded.Foot appearance and function were assessed pre-operatively and at final follow-up with the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system. Results Primary etiologies were cerebral palsy in 11 cases (11/25,44%),tethered-cord syndrome in 2 (2/25,8%),mucopolysaccharidosis in 1 (1/25,4%),muscular dystrophy in 1 (1/25,4%),hereditary motor-sensory neuropathy in 1 (1/25,4%),and unknown causes in 9 (9/25,36%).Surgical procedures performed (per 34 feet) were tibialis anterior lateral transfer in 100% (34/34),Achilles tendon lengthening in 85.3% (29/34),partial plantar-fascia release in 73.5% (25/34),gastrocnemius aponeurotic release in 14.7% (5/34),split tibialis posterior transfer in 11.8% (4/34),split extensor hallucis longus tendon retroposition in 8.8% (3/34),and V-shaped first-metatarsal-base osteotomy with Kirschner-wire fixation in 5.9% (2/34).All feet were immobilized in casts post-operatively;all wounds healed without infection.One foot relapsed,giving a recurrence rate of 2.9% (1/34).At final follow-up,the mean AOFAS ankle-hindfoot score improved significantly from 58.84±3.07 pre-operatively to 91.88±4.06 (t=38.895,P<0.001).Outcomes were rated excellent in 20 patients (20/25,80%),good in 4 (4/25,16%),and fair in 1 (1/25,4%). Conclusions Transferring the tibialis anterior tendon to the peroneus tertius followed by weight-bearing walking-cast immobilization offers significant short-term improvement in ankle-hindfoot function for children with acquired equinovarus foot and is associated with a low complication rate.
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备注/Memo
收稿日期:2025-4-28。
通讯作者:胡新永,Email:huxinyonghxy@sina.com