Napiontek Marek, Pietrzak Krzysztof
Ortop Poliklinika, Poznan, Poland,
Eur J Orthop Surg Traumatol. 2015 Feb;25(2):391-7. doi: 10.1007/s00590-014-1498-9. Epub 2014 Jun 27.
The purpose of the paper was to present the results of surgical treatment of foot deformities in peripheral neuropathies using bone procedures: both joint preserving and with joint arthrodesis. The study included 26 patients, 14 males and 12 females (43 feet). The age of the patients at surgery ranged from 5 to 55 years (average 23 years). The follow-up ranged from 0.5 to 15 years (average 4.3 years). Seventeen patients presented Charcot-Marie-Tooth disease, three Friedreich's ataxia and six peripheral motor and sensory neuropathies of undetermined nature. Sixteen patients had bilateral procedures. Four patients had to be re-operated during the follow-up. The patients were divided into four groups depending on the age and the surgical technique applied. The groups I and II (9 children, 17 feet) included patients with growth plate still present in the foot just before surgery. In the groups III and IV (17 adults, 26 feet), bone growth was completed. The assessment of all patients based on a modified AOFAS scale ranged from 44 to 105 points (mean 83.7; SD 17.5). The assessment on the subjective scale ranged from 3 to 10 points (mean 7.4; SD 2.1). The assessment of quality of life on the WOMAC scale ranged from 0 to 41 points (mean 15.7; SD 13.2). All patients stated that they would decide to undergo the treatment again. For groups I and II, joint preserving surgeries gave better results; however, the results could not be statistically confirmed. The results for the groups III and IV were inconclusive as to which surgical techniques should be preferred, arthrodesis or joint preserving. The results show that none of the surgical techniques used for correction of foot deformities in motor-sensory polyneuropathies seems to be preferable.
本文旨在介绍采用保关节和关节融合骨手术治疗周围神经病变足部畸形的结果。该研究纳入了26例患者，其中男性14例，女性12例（共43只脚）。手术时患者年龄在5至55岁之间（平均23岁）。随访时间为0.5至15年（平均4.3年）。17例患者患有腓骨肌萎缩症，3例患有弗里德赖希共济失调，6例患有性质不明的周围运动和感觉神经病变。16例患者接受了双侧手术。4例患者在随访期间需要再次手术。根据年龄和所采用的手术技术，将患者分为四组。第一组和第二组（9名儿童，17只脚）包括术前足部生长板仍存在的患者。第三组和第四组（17名成人，26只脚）骨生长已完成。基于改良的美国足踝外科协会（AOFAS）评分对所有患者的评估结果为44至105分（平均83.7分；标准差17.5）。主观评分范围为3至10分（平均7.4分；标准差2.1）。采用西大略和麦克马斯特大学骨关节炎指数（WOMAC）量表对生活质量的评估结果为0至41分（平均15.7分；标准差13.2）。所有患者均表示会再次决定接受该治疗。对于第一组和第二组，保关节手术效果更好；然而，结果未得到统计学证实。关于第三组和第四组，对于哪种手术技术（关节融合或保关节）更可取尚无定论。结果表明，用于矫正运动感觉性多发性神经病足部畸形的手术技术似乎都没有明显优势。
