Weiner Dennis S, Morscher Melanie, Junko Jeffrey T, Jacoby Jeffrey, Weiner Bradley
Department of Pediatric Orthopaedic Surgery, Children's Hospital Medical Center of Akron, Akron, OH, USA.
J Pediatr Orthop. 2008 Jan-Feb;28(1):68-80. doi: 10.1097/bpo.0b013e31815a5fba.
In the early 1970s, the Akron dome osteotomy was developed as a salvage surgical option to manage rigid cavus deformity of the foot. This study represents an updated review of surgical cases between 1972 and 2001 constituting 89 patients representing 139 feet who were followed at least 2 years after the index operative procedure. Only cases achieving an unsatisfactory result followed less than 2 years were included.
A retrospective review of cases (all operated by D.S.W.) was conducted by clinical examination and chart review of all 89 cases representing 139 feet.
A satisfactory result was considered pain-free, at least 75% plantigrade foot in contact with the floor without abnormal symptomatic pressure areas, free of any significant deformity requiring surgical management. A satisfactory result was obtained in 106 (76%) and unsatisfactory result in 33 feet (24%). When separating the patients into those younger than 8 years and those older than 8 years, 67% of the patients younger than 8 years had a satisfactory result, and 82% older than 8 years had a satisfactory result. No significant complications were encountered. Because the surgery is located at the apex of the deformity in frontal, lateral, and plantar planes at the confluence of the longitudinal and transverse arches, multiplanar surgical correction was obtained in all cases at the time of the initial surgery. Currently, the most common causes of cavus deformity seen in our series were the sequelae of idiopathic talipes equinus varus clubfoot, congenital metatarsus varus, and assorted neuromuscular disorders, including Charcot-Marie-Tooth disease, cerebral palsy, and arthrogryposis.
On the basis of this review, the Akron dome midfoot osteotomy is a very valuable salvage procedure in the management of the rigid cavus deformity in children.
20世纪70年代初，阿克伦穹顶截骨术作为一种挽救性手术方案被开发出来，用于治疗足部僵硬性高弓畸形。本研究对1972年至2001年间的手术病例进行了更新回顾，这些病例包括89名患者共139只脚，在首次手术至少2年后进行了随访。仅纳入了随访时间少于2年且结果不满意的病例。
通过对所有89例患者共139只脚进行临床检查和病历回顾，对病例（均由D.S.W.进行手术）进行回顾性研究。
满意的结果被定义为无痛，至少75%的足底与地面接触且无异常症状性压迫区域，无任何需要手术治疗的明显畸形。106只脚（76%）获得了满意的结果，33只脚（24%）结果不满意。将患者分为8岁以下和8岁以上两组，8岁以下患者中有67%获得了满意的结果，8岁以上患者中有82%获得了满意的结果。未出现重大并发症。由于手术位于额状面、侧面和跖面畸形的顶点，即纵弓和横弓的交汇处，所有病例在初次手术时均实现了多平面手术矫正。目前，在我们的系列病例中，高弓畸形最常见的原因是特发性马蹄内翻足、先天性跖内翻以及各种神经肌肉疾病的后遗症，包括夏科-马里-图斯病、脑瘫和关节挛缩症。
基于本综述，阿克伦穹顶中足截骨术在治疗儿童僵硬性高弓畸形方面是一种非常有价值的挽救性手术。
