Abstract：Objective To assess clinical and radiographic outcomes of individualized treatment strategies for the relapsed clubfoot.Methods From February 2011 to December 2015，a total of 28 patients( 45 feet) were admitted to our hospital and treated by individual treatment strategies，which including 16 male patients(25 feet)and 12 female patients(20 feet)，the mean age of the patients was 9.2 years (5 to 14).The Maryland score，VAS score，satisfaction survey，talar to first metatarsal angle (Meary’sangle)，calcaneal to 5th metatarsal angle (C5MT)of AP，talar to first metatarsal angle (Meary’s angle)，kite angle of lateral positon of preopration and postoperation were compared.Results All patients were followed up for 12 to 33 months，with an average of (21.5±1.8)months.3 cases (4 feet) suffered postoperative wound superficial infection，and were cured by antibiotics.The Maryland score of end time evidently improved(P＜0.01).The VAS score of the end follow-up was obvously reduced (P＜0.01).The satisfaction suvery of paitents showed 18 paitents were very satisfactory，8 paitents were satisfactory，and 2 paitents felt general.The angles of T1MT，T2MT，C5MT，Meary，and Kite were significantly improved(P＜0.01).Conclusion The individualized treatment strategies for the patients with relapsed clubfoot deformity in children can obtain satisfactory results.
［1］Boehm S，Sinclair M.Foot abduction brace in the Ponseti method for idiopathic clubfoot deformity：torsional deformities and compliance［J］.J Pediatr Orthop，2007，27(6)：712-716.
［2］Avilucea FR，Szalay EA，Bosch PP，et al.Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America［J］.J Bone Joint Surg(Am)，2009，91(3)：530-540.
［3］Saetersdal C，Fevang JM，Fosse L，et al.Good results with the Ponseti method：A multicenter study of 162 clubfeet followed for 2~5 years［J］.Acta Orthop，2012，83(3)：288.
［4］Shabtai L，Specht SC，Herzenberg JE.Worldwide spread of the Ponseti method for clubfoot［J］.World J Orthop，2014，5(5)：585-590.
［5］Radler C，Mindler GT，Riedl K，et al.Midterm results of the Ponseti method in the treatment of congenital clubfoot［J］.Int Orthop，2013，37(9)：1827-1831.
［6］Mindler GT，Kranzl A，Lipkowski CA，et al.Results of gait analysis including the Oxford foot model in children with clubfoot treated with the Ponseti method［J］.J Bone Joint Surg(Am)，2014，96(19)：1593-1599.
［7］Cooper DM，Dietz FR.Treatment of idiopathic clubfoot.A thirty-year follow-up note［J］.J Bone Joint Surg(Am)，1995，77(10)：1477-1489.
［8］Lehman WB，Mohaideen A，Madan S，et al.A method for the early evaluation of the Ponseti(Iowa) technique for the treatment of idiopathic clubfoot［J］.J Pediatr Orthop B，2003，12(2)：133.
［9］Farsetti P，Caterini RF，Potenza V，et al.Anterior tibial tendon transfer in relapsing congenital clubfoot：long-term follow-up study of two series treated with a different protocol［J］.J Pediatr Orthop，2006，26(1)：83.
［10］Schleicher I，Lappas K，Klein H，et al.Follow up of complete subtalar release for clubfoot——Evolution of different scores［J］.Foot Ankle Surg，2012，17(3)：55-61.
［11］Sanders R，Fortin P，Dipasquale T，et al.Operative treatment in 120 displaced intraarticular calcaneal fractures.Results using a prognostic computed tomography scan classification［J］.Clin Orthop Relat Res，1993(290)：87.
［12］Turner NM，Aj VDL，Draaisma JM，et al.Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills［J］.Med Educ，2008，42(5)：503-511.
［13］Ippolito E，Fraracci L，Farsetti P，et al.The influence of treatment on the pathology of club foot.CT study at maturity［J］.J Bone Joint Surg(Br)，2004，86(4)：574-580.
［14］Handelsman JE，Badalamente MA.Club foot：a neuromuscular disease［J］.Dev Med Child Neurol，1982，24(1)：3.
［15］Loren GJ，Karpinski NC，Mubarak SJ.Clinical implications of clubfoot histopathology［J］.J Pediatr Orthop，1998，18(6)：765.
［16］Ahmed M，Ahmed N，Khan KM，et al.Sensory hypoinnervation in club foot［J］.J Bone Joint Surg(Br)，2004，86(8)：1163.
［17］Morcuende JA，Dolan LA，Dietz FR，et al.Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method［J］.Pediatrics，2004，113(2)：376.
［18］Dragoni M，Farsetti P，Vena G，et al.Ponseti Treatment of Rigid Residual Deformity in Congenital Clubfoot After Walking Age［J］.J Bone Joint Surg(Am)，2016，98(20)：1706-1712.
［19］Holt JB，Oji DE，Yack HJ，et al.Long-term results of tibialis anterior tendon transfer for relapsed idiopathic clubfoot treated with the Ponseti method：a follow-up of thirty-seven to fifty-five years［J］.J Bone Joint Surg(Am)，2015，97(1)：47.
［20］Masrouha KZ，Morcuende JA.Relapse after tibialis anterior tendon transfer in idiopathic clubfoot treated by the Ponseti method［J］.J Pediatr Orthop，2012，32(1)：81.
［21］Luckett MR，Hosseinzadeh P，Ashley PA，et al.Factors predictive of second recurrence in clubfeet treated by ponseti casting［J］.J Pediatr Orthop，2015，35(3)：303.
［22］Loza ME，Bishay SN，El-Barbary HM，et al.Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot［J］.Ann R Coll Surg Engl，2010，92(8)：673-679.
［23］Schaefer D，Hefti F.Combined cuboid/cuneiform osteotomy for correction of residual adductus deformity in idiopathic and secondary club feet［J］.J Bone Joint Surg(Br)，2000，82(6)：881.
［24］Lourenco AF，Dias LS，Zoellick DM，et al.Treatment of residual adduction deformity in clubfoot：the double osteotomy［J］.J Pediatr Orthop，2001，21(6)：713-718.
［25］Mahadev A，Munajat I，Mansor A，et al.Combined Lateral and Transcuneiform without Medial Osteotomy for Residual Clubfoot for Children［J］.Clin Orthop Relat Res，2009，467(5)：1319.
［26］Elgeidi A，Abulsaad M.Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant clubfoot deformity(the "beanshaped" foot)［J］.J Child Orthop，2014，8(5)：399-404.
［27］Lehman WB，Atar D，Bash J，et al.Results of complete soft tissue clubfoot release combined with calcaneocuboid fusion in the 4-year to 8-year age group following failed clubfoot release［J］.J Pediatr Orthop B，1999，8(3)：181-186.
［28］Chu A，Sonia C，Sala DA，et al.Calcaneocuboid arthrodesis for recurrent clubfeet：what is the outcome at 17-year follow-up?［J］.J Child Orthop，2014，8(1)：43-48.
［29］Ettl V，Kirschner S，Krauspe R，et al.Midterm results following revision surgery in clubfeet［J］.Int Orthop，2009，33(2)：515-520.
［30］Franke J，Mattner HR，Hein G，et al.Operative treatment of congenital clubfoot［J］.Beitr Orthop Traumatol，1985，32(12)：600-611.
［31］Eidelman M，Katzman A.Treatment of complex tibial fractures in children with the taylor spatial frame［J］.Orthopedics，2011，31(10)：993.
［32］Eidelman M，Keren Y，Katzman A.Correction of residual clubfoot deformities in older children using the Taylor spatial butt frame and midfoot Gigli saw osteotomy［J］.J Pediatr Orthop，2012，32(5)：527.
［33］Gupta P，Bither N.Ilizarov in relapsed clubfoot：a necessary evil?［J］.J Pediatr Orthop B，2013，22(6)：589-594.
［34］Khanfour AA.Ilizarov techniques with limited adjunctive surgical procedures for the treatment of preadolescent recurrent or neglected clubfeet［J］.J Pediatr Orthop B，2013，22(3)：240-248.
［35］Refai MA，Song SH，Song HR.Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children?［J］.Clin Orthop Relat Res，2012，470(7)：1992.
晋公网安备 14010702070875号