腓骨肌萎缩症患者严重肘关节畸形的外科治疗

                               
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A successful adjustable treatment algorithm for the correction of cavovarus foot deformity requires soft-tissue balancing procedures, in particular total split posterior tibial tendon transfer (T-SPOTT), in combination with adjunctive corrective procedures depending on the degree of deformity.

Cavovarus foot deformity can become debilitating, causing pain and decreasing the ability to perform daily activities1-5. The most common causes of the deformity are neurologic6, and these require a more complex strategy combining soft-tissue balancing and osseous corrective procedures7,8. Hereditary motor and sensory neuropathy, also collectively known as Charcot-Marie-Tooth disease, describes a progressive disease of variable genetic inheritance pattern, resulting in malfunction of the myelin sheath leading to muscle atrophy and muscle imbalance1-5. This disorder is the most frequent neurologic cause of cavovarus deformity9. Various other disorders may result in cavovarus deformity—for example, central nervous system disorders (such as cerebral palsy and traumatic brain injuries, among others), spinal cord or peripheral nervous system disorders (spina bifida, syringomyelia, and neoplastic disorder, to name a few), and others (such as muscular dystrophy, arthrogryposis multiplex congenita, and compartment syndrome)10. Hence, it is of great importance to determine the underlying cause of the deformity prior to surgical correction, as some of the causes require specific treatment and may be associated with progressive disease. Furthermore, prior to surgical treatment, a variety of diagnostic tools should be used to determine the best treatment option. These include standardized clinical examination (range-of-motion measurements, muscle-power tests, and the Coleman block test), weight-bearing radiographic studies, and dynamic studies (dynamic pedobarography and instrumented three-dimensional gait analysis with a foot model).