PDF(Pubmed)
Abstract：
BACKGROUND: Clubfoot is a common congenital deformity. The Ponseti technique, involving early corrective manipulations followed by applying long leg casts and Achilles tenotomy, is widely accepted as the preferred treatment. Rapid tendon healing after surgery has been documented, but the aspect regarding long-term tendon structure and properties is not known. Three cases of Achilles tendon rupture in adolescents previously treated for clubfoot have been described in the literature. As rupture is a rare event in this age group, a possible correlation with previous surgery has been hypothesized. The primary aim of the study was to compare the ultrasound findings of the Achilles tendon in patients treated for clubfoot, between patients treated with casting alone and with patients who underwent surgery (percutaneous tenotomy or Z-plasty lengthening).
METHODS: There were 22 asymptomatic patients (34 feet) with a median age of 12 years, previously treated for clubfoot, that were recruited for this study; the patients underwent an Achilles tendon ultrasound examination during a follow-up outpatient visit.
RESULTS: A greater thickness and increased number of structural alterations with the presence of hypoechoic areas of the operated tendons compared with those treated with plaster alone were observed (p-value: 0.0498 and <0.001, respectively). These ultrasound findings were indicative of tendon suffering, as seen in tendinopathies.
CONCLUSIONS: The presence of ultrasound alterations in asymptomatic patients operated on for clubfoot requires careful control of the extrinsic factors of tendinopathy in order to reduce the risk of subcutaneous rupture.
METHODS: There were 22 asymptomatic patients (34 feet) with a median age of 12 years, previously treated for clubfoot, that were recruited for this study; the patients underwent an Achilles tendon ultrasound examination during a follow-up outpatient visit.
RESULTS: A greater thickness and increased number of structural alterations with the presence of hypoechoic areas of the operated tendons compared with those treated with plaster alone were observed (p-value: 0.0498 and <0.001, respectively). These ultrasound findings were indicative of tendon suffering, as seen in tendinopathies.
CONCLUSIONS: The presence of ultrasound alterations in asymptomatic patients operated on for clubfoot requires careful control of the extrinsic factors of tendinopathy in order to reduce the risk of subcutaneous rupture.
摘要：
背景：马蹄内翻足是一种常见的先天性畸形。Ponseti技术,包括早期矫正操作，然后应用长腿铸型和跟腱切开术，被广泛接受为首选治疗。手术后肌腱快速愈合已有文献记载，但是关于长期肌腱结构和特性的方面尚不清楚。文献中已经描述了三例先前接受过马蹄内翻足治疗的青少年跟腱断裂。由于破裂在这个年龄段是罕见的事件，有人推测可能与以前的手术相关.该研究的主要目的是比较接受马蹄内翻足治疗的患者跟腱的超声检查结果，仅接受铸造治疗的患者和接受手术（经皮肌腱切开术或Z形成形术延长术）的患者之间的差异。
方法：有22名无症状患者（34英尺），中位年龄为12岁，以前治疗过马蹄内翻足,本研究招募的患者;患者在随访门诊期间接受了跟腱超声检查。
结果：与单独使用石膏治疗的肌腱相比，随着手术肌腱的低回声区域的存在，观察到更大的厚度和更多的结构改变（p值：分别为0.0498和<0.001）。这些超声发现表明肌腱疼痛，如在肌腱病中看到的。
结论：无症状马蹄足手术患者存在超声改变，需要仔细控制肌腱病的外在因素，以降低皮下破裂的风险。
方法：有22名无症状患者（34英尺），中位年龄为12岁，以前治疗过马蹄内翻足,本研究招募的患者;患者在随访门诊期间接受了跟腱超声检查。
结果：与单独使用石膏治疗的肌腱相比，随着手术肌腱的低回声区域的存在，观察到更大的厚度和更多的结构改变（p值：分别为0.0498和<0.001）。这些超声发现表明肌腱疼痛，如在肌腱病中看到的。
结论：无症状马蹄足手术患者存在超声改变，需要仔细控制肌腱病的外在因素，以降低皮下破裂的风险。
