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目的评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效。方法收集1998年5月-2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足。男28例45足,女25例40足;年龄2.5～14.0岁,平均6.8岁。痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足。患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形。合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正。结果患儿均获随访,随访时间0.5～11.2 a,平均2.3 a。1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降。53例85足均获满意疗效,优55足,良30足,优良率达100%。结论跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法。
Objective To evaluate the efficacy of Achilles tendon prolongation in children with cerebral palsy spastic clubfoot. Methods Fifty-five patients (85 feet) with cerebral palsy type clubfoot were treated with Achilles tendon prolongation from May 1998 to June 2011. There were 28 males and 45 females, 25 females and 40 females, aged from 2.5 to 14.0 years, with an average of 6.8 years. Spasm level by Ashworth 5-level assessment: 3 12 feet, 4 38 feet, 5 35 feet. Children were able to walk, mental development and lower limb muscle strength was normal, with varying degrees of increased muscle tone, tendon hyperreflexia, ankle clonus and Babinski sign positive, no significant varus, valgus and flatfoot deformity, X-ray film Prompt significant bone deformity. Five cases of bilateral adductor retraction deformity and two cases of knee flexion deformity were surgically corrected before or at the same period. Results All patients were followed up for 0.5 ~ 11.2 years with an average of 2.3 years. One case had incision rupture and ruptured Achilles tendon at 2 weeks after operation. Achilles tendon was anastomosed again after operation, and the postoperative recovery was good. No postoperative triceps muscle strength was found in the children. 53 cases of 85 feet were satisfactory results, excellent 55 feet, good 30 feet, good rate of 100%. Conclusion Achilles tendon prolongation using biomechanical principles, based on the Achilles tendon extension to the Achilles tendon to the posterior margin, shortening the Achilles tendon to the ankle arm, balance the ankle dorsiflexion And plantar flexor muscle strength, long-term effect is good, is a better treatment of children with cerebral palsy spastic clubfoot.