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Abstract：
Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood.A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age.Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction.All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat.Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group.This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: EFORT Open Rev 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110.
摘要：
马蹄挛缩是马蹄内翻足复发时最常见的畸形，可引起疼痛和功能限制。这对整个童年时期的整形外科医生提出了挑战。根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价。研究包括：(I)原创文章，（ii）研究复发性特发性马蹄内翻足的治疗，（iii）至少部分研究人群主要是马蹄畸形，和(iv)独立行走年龄的儿科研究人群。包括9项研究，共163名患者（207英尺）。研究提出了五种管理范式：腓肠肌-比目鱼复合体释放，广泛的后部软组织和关节松解术，胫骨远端前半上皮肌固定术，胫骨远端截骨术,和圆形框架分心。所有方法都报告了我们选择的至少一个结果领域的成功：平坦化状态，运动范围,临床结果评分，功能状态，射线照相结果，患者报告的结果，和并发症。年龄较小的儿童倾向于通过软组织释放来管理,而年龄较大的儿童倾向于需要更广泛的骨/关节手术。手术治疗的足部复发更难治疗。不同治疗方法的比较受到文献规模小、证据水平低的限制，以及缺乏一致的结果报告。因此，不可能推荐任何年龄组的任何一种治疗选择。这篇综述强调了需要一个经过验证的核心结果集，以便对马蹄畸形的管理进行高质量的研究。引用这篇文章：EFORTOpenRev2021；6：354-363。DOI：10.1302/2058-5241.6.200110。
