Crawford A H, Kucharzyk D, Roy D R, Bilbo J
Children's Hospital Medical Center, Cincinnati, Ohio 45229.
J Bone Joint Surg Am. 1990 Jul;72(6):840-5.
A new approach was developed for the treatment of planovalgus feet in children who have spastic cerebral palsy and are less than six years old. The procedure consists of subtalar stabilization (arthroereisis) with a Vitallium staple, and it corrects alignment, restores balance, and allows continued function. It is safe, technically simple, and efficient. Between 1980 and 1988, forty-eight arthroereises were done. The results of thirty-one procedures in twenty patients who were two to ten years and ten months old at the time of the operation were followed for an average of 4.1 years (range, two to seven years). Approximately 85 per cent of the results were excellent or good. Only one foot needed a revision; this was due to migration of the staple. At the most recent follow-up, the talocalcaneal angle had not changed in about 50 per cent of the feet. In another seven, the change ranged from 5 to 10 degrees. All of these patients had a satisfactory result. In all but three feet, the goal of maintaining the stability of the talocalcaneal joint without orthotics or osseous fusion was achieved. Originally, the procedure was done only in patients who were less than six years old, but, because of its success, the indications were extended to children of any age who had severely involved and neurologically compromised feet. Satisfactory results were obtained in the older children as well.
一种新的治疗方法被开发出来，用于治疗患有痉挛性脑瘫且年龄小于6岁儿童的扁平外翻足。该手术包括用一个维他灵U形钉进行距下关节稳定术（关节造形术），它可矫正对线、恢复平衡并允许持续的功能。它安全、技术上简单且有效。1980年至1988年间，共进行了48例关节造形术。对20例手术时年龄在2岁至10岁零10个月的患者进行的31例手术结果进行了平均4.1年（范围为2至7年）的随访。大约85%的结果为优或良。只有一只脚需要翻修，这是由于U形钉移位所致。在最近的随访中，约50%的足部距跟角未发生变化。在另外7例中，变化范围为5至10度。所有这些患者的结果均令人满意。除3只脚外，其余所有脚均实现了在无矫形器或骨融合的情况下维持距跟关节稳定性的目标。最初，该手术仅针对年龄小于6岁的患者进行，但由于其成功，适应证已扩大到任何年龄且足部严重受累和神经功能受损的儿童。年龄较大的儿童也获得了满意的结果。
