Dobbs Matthew B, Purcell Derek B, Nunley Ryan, Morcuende Jose A
Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2006 Jun;88(6):1192-200. doi: 10.2106/JBJS.E.00402.
The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus.
The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient.
Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25 degrees and the mean plantar flexion was 33 degrees . Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age.
Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.
特发性先天性垂直距骨的治疗传统上包括手法复位和石膏固定，随后进行广泛的软组织松解。然而，这种治疗方法常常导致足部严重僵硬及其他并发症。本研究的目的是评估一种新的手法复位和石膏固定方法，该方法基于庞塞蒂（Ponseti）治疗马蹄内翻足畸形所采用的原则，随后对患有特发性先天性垂直距骨的患者进行距舟关节克氏针固定及跟腱经皮切断术。
回顾性分析连续11例患者共19只患有特发性先天性垂直距骨畸形的足部病例，这些病例在接受系列手法复位和石膏固定治疗后至少随访两年，后续接受了包括跟腱经皮切断术（所有19只足）、胫骨前肌腱部分延长术（2只足）或腓骨短肌腱部分延长术（1只足）以及距舟关节经皮克氏针固定术（12只足）的有限手术。手法复位及石膏固定的原则与庞塞蒂用于矫正马蹄内翻足畸形的原则相似，但施加的力量方向相反。在就诊时、术后即刻以及最近一次随访时对患者进行临床和影像学评估。比较这些时间点获得的影像学测量数据。此外，将最终评估时的影像学数据与同年龄患者的正常值进行比较。
所有19只足在临床和影像学上均获得了初始矫正。平均需要5次石膏固定来完成矫正。没有患者接受广泛的手术松解。在最终评估时，平均踝关节背屈为25度，平均跖屈为33度。3例患者出现舟骨背侧半脱位，其中无一例接受距舟关节克氏针固定。在最近一次随访时，与治疗前值相比，所有测量的影像学参数均有显著改善（p < 0.0001），且所有测量角度均在患者年龄对应的正常值范围内。
对于患有特发性先天性垂直距骨的患者，在至少两年的随访中，系列手法复位和石膏固定，随后进行距舟关节克氏针固定及跟腱经皮切断术，在足部的临床外观、足部功能以及影像学测量的畸形矫正方面均取得了优异的效果。
