Ahn Ji-Yong, Lee Ho-Seong, Kim Chul-Ho, Yang Jin-Pil, Park Soo-Sung
Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
Foot Ankle Int. 2014 Jul;35(7):677-82. doi: 10.1177/1071100714528494. Epub 2014 Mar 27.
We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities.
This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed.
All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time (r s = -.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up.
At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint.
Level IV, case series.
我们研究了跟骨延长术治疗小儿扁平外翻足畸形后跟骰（CC）关节半脱位的影像学变化。
本研究纳入了1999年至2011年间接受跟骨延长术的24例患者，共44只扁平外翻足畸形，患者平均年龄9.7岁（范围8至13岁）。平均随访期为25个月（范围12至159个月）。回顾了术后即刻、术后3个月及末次随访时足部负重位的前后位（AP）和侧位X线片，并用于趋势分析。在足部的AP位和侧位片上测量CC关节半脱位的百分比。评估CC关节半脱位百分比与随访期之间的相关性。
所有足部在术后即刻侧位平片上均显示CC关节背侧半脱位。CC关节背侧半脱位的中位百分比从术后即刻评估时的26.0%（范围10.0至67.0）改善至术后3个月评估时的16.5%（范围7.0至47.0，P = .0001），并在末次随访时改善至11%（范围2.0至30.0，P = .0003）。随时间的趋势分析表明，跟骨延长术后CC关节半脱位百分比总体上随时间下降（rs = -.67，P = .001）。末次随访时，没有患者在CC关节出现骨关节炎改变或跟骨截骨部位不愈合。
在中期随访中，CC关节半脱位随时间逐渐缓解，没有CC关节骨关节炎改变的证据。
IV级，病例系列。
