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目的:分析儿童先天性马蹄内翻足手术失败原因并提出预防措施。方法:对89例111足先天性马蹄内翻足首次术后畸形复发(66例87足)或继发外翻(23例24足)原因进行分析。结果:手术失败原因包括单纯软组织松解手术34足,转移肌肉发育差9足,肌力平衡手术中解剖定位错误、转移肌腱附丽点选择不当51足,术后石膏松脱致附丽点脱落17足。结论:在彻底软组织松解、纠正畸形的同时,肌腱转移应选择发育良好的肌肉、正确的肌腱附丽点位置(第3楔状骨为宜)及合适的张力以建立有效的肌力平衡并注意加强术后石膏管理是预防手术失败的主要措施。术后应定期复查,对手术失败病例早发现、早期正确再次手术处理,仍可取得较好疗效。
Objective: To analyze the causes of failure of pediatric congenital clubfoot and to provide preventive measures. Methods: Eighty-nine patients with 111 feet of congenital clubfoot recurrence (66 cases, 87 feet) or secondary eversion (23 cases, 24 feet) were analyzed. Results: The causes of operation failure included simple soft tissue loosening operation of 34 feet, poor transfer of muscle development in 9 feet, anatomical positioning errors in muscle strength balance operation, improper transfer of tendon attached Li Li inappropriate choice of 51 feet, postoperative gypsum release caused by Li Li off 17 feet . CONCLUSIONS: While complete soft tissue release and correction of deformities, tendon transfer should be performed with well-developed muscle. Appropriate tendon attachment (third wedge-shaped bone is appropriate) and appropriate tension to establish effective muscle strength balance and attention to strengthening Postoperative gypsum management is to prevent the failure of the main measures. After surgery should be regularly reviewed, early detection of surgical failure cases, the early correct re-operation, can still achieve better results.