Viehweger Elke, Jacquemier Michel, Launay Franck, Giusiano Bernard, Bollini Gérard
Pediatric Orthopaedic Department, Timone Children's University Hospital, Marseille, France.
Clin Orthop Relat Res. 2005 Dec;441:356-65. doi: 10.1097/01.blo.0000180605.535851.82.
Three-dimensional concepts underlie various congenital foot deformities in the midfoot. We wondered whether the first cuneiform osteotomy, usually indicated for forefoot correction, had an effect on the hindfoot. We retrospectively studied 18 patients (31 feet) with metatarsus adductus and varus who had a biplane first cuneiform osteotomy between 1994 and 2001. No patients had associated malformations or neuromuscular disease. All had persistent pain and functional complaints for at least 2 years before surgery, and all had a minimum followup of 2 years. Group A (13 feet) with forefoot adduction without hindfoot valgus had an isolated first cuneiform osteotomy. Group B (18 feet) with slight forefoot adduction, hindfoot valgus, and supination after hindfoot valgus correction had first cuneiform osteotomy and a subtalar arthrodesis. At 5 years mean followup we evaluated multiple measurements on preoperative and followup weightbearing radiographs. Complementary demographic information and clinical patient information were collected. First cuneiform osteotomy was associated with architectural changes in hindfoot bone angles. This finding suggests new surgical approaches.
Therapeutic Study. Level IV (Case series). See the Guidelines for Authors for a complete description of levels of evidence.
三维概念是中足各种先天性足部畸形的基础。我们想知道通常用于前足矫正的第一楔骨截骨术是否会对后足产生影响。我们回顾性研究了1994年至2001年间接受双平面第一楔骨截骨术的18例（31足）内收内翻足患者。所有患者均无相关畸形或神经肌肉疾病。所有患者在手术前均有持续至少2年的疼痛和功能障碍主诉，且所有患者的随访时间均至少为2年。A组（13足）仅有前足内收而无后足外翻，接受单纯第一楔骨截骨术。B组（18足）有轻度前足内收、后足外翻，且后足外翻矫正后有旋后，接受第一楔骨截骨术和距下关节融合术。在平均5年的随访中，我们对术前和随访时的负重X线片进行了多项测量。收集了补充人口统计学信息和临床患者信息。第一楔骨截骨术与后足骨角度的结构变化有关。这一发现提示了新的手术方法。
治疗性研究。IV级（病例系列）。有关证据水平的完整描述，请参见作者指南。
