Gursu Sarper, Bahar Hakan, Camurcu Yalkin, Yildirim Timur, Buyuk Fettah, Ozcan Cagri, Sahin Vedat
Baltalimani Metin Sabanci Bone and Joint Diseases Hospital, Istanbul, Turkey
Baltalimani Metin Sabanci Bone and Joint Diseases Hospital, Istanbul, Turkey.
Foot Ankle Int. 2015 Jan;36(1):46-50. doi: 10.1177/1071100714550649. Epub 2014 Nov 17.
Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults.
Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months).
Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02).
The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone.
Level IV, case series.
成人重度马蹄内翻足畸形是一个具有挑战性的问题。保守治疗很少有效，手术选择也有限。本研究的目的是评估距骨切除术和带髓内钉固定的胫跟关节融合术治疗成人重度马蹄内翻畸形的效果。
2010年3月至2013年2月期间，对12例（平均年龄39岁，范围15 - 70岁）足部重度马蹄内翻畸形患者采用距骨切除术和带髓内钉固定的胫跟关节融合术进行治疗。平均随访时间为20个月（范围10 - 37个月）。
所有患者均在平均12周（范围8 - 17周）时实现胫跟融合。术前，所有患者均有严重、不可复位的马蹄内翻畸形；在最后一次随访时，几乎所有足部都有轻度残留畸形，但足能放平，且不需要支具或矫形器。美国足踝外科协会（AOFAS）踝关节平均评分从术前的41.1（范围8 - 66）提高到术后的78.4（范围67 - 86）（P = .02）。视觉模拟评分法（VAS）平均评分也有类似改善，从术前的6.3（范围2 - 10）降至术后的0.8（范围0 - 4）（P = .02）。
距骨切除术和胫跟关节融合术相结合在矫正成人严重僵硬性马蹄内翻畸形方面是有效的。去除距骨导致软组织松弛，使畸形矫正更容易。胫跟关节融合术实现了足部稳定，而没有单独距骨切除术相关的问题。
IV级，病例系列。
