Cook Emily A, Cook Jeremy J, Basile Philip
Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Podiatric Surgery, Department of Surgery, Boston, MA 02215, USA.
J Foot Ankle Surg. 2011 Jul-Aug;50(4):395-401. doi: 10.1053/j.jfas.2011.03.019.
A case-control study was undertaken to identify differences in patients with flexible flatfoot deformity who required explantation of subtalar arthroereisis compared with those who did not. All patients who required removal of a self-locking wedge-type subtalar arthroereisis were identified between 2002 and 2008. Propensity scores matched 22 explanted subtalar arthroereises to 44 controls (nonexplanted arthroereises), resulting in a total of 66 implants that met all inclusion and exclusion criteria. Multivariate logistic regression found that patients who required explantation had a greater odds of radiographic undercorrection, determined from radiographic anteroposterior talar-first metatarsal angles postoperatively, P = .0012, odds ratio (OR) = 1.175 (95% confidence interval [CI] 1.066 to 1.295), or residual transverse plane-dominant deformities, as determined from radiographic calcaneocuboid abduction angles postoperatively, P = .05, OR = 1.096 (95% CI 1.06 to 1.203). Patients with smaller postoperative anteroposterior talocalcaneal angles had a 16.7% reduction in odds for arthroereisis explantation (P = .0019) (95% CI 6.5% to 25.8%). Age, gender, implant size, shape, duration, implant position, surgeon experience, and concomitant procedures were not statistically different between the 2 groups. This study helps identify key factors that may result in subtalar arthroereisis explantation.
开展了一项病例对照研究，以确定需要取出距下关节稳定器的柔性扁平足畸形患者与无需取出的患者之间的差异。2002年至2008年间确定了所有需要取出自锁楔形距下关节稳定器的患者。倾向评分将22例取出的距下关节稳定器与44例对照（未取出关节稳定器）进行匹配，共有66个植入物符合所有纳入和排除标准。多因素逻辑回归分析发现，需要取出植入物的患者术后X线片上距骨-第一跖骨前后角显示矫正不足的几率更高，P = 0.0012，比值比（OR）= 1.175（95%置信区间[CI]为1.066至1.295），或者术后X线片跟骰关节外展角显示残留的以横断面为主的畸形几率更高，P = 0.05，OR = 1.096（95%CI为1.06至1.203）。术后距骨-跟骨前后角较小的患者取出关节稳定器的几率降低了16.7%（P = 0.0019）（95%CI为6.5%至25.8%）。两组之间的年龄、性别、植入物大小、形状、持续时间、植入物位置、外科医生经验和伴随手术在统计学上无差异。本研究有助于确定可能导致距下关节稳定器取出的关键因素。
