II期成人获得性平足畸形重建后足跟的最佳位置
Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity.
作者信息
Conti Matthew S, Ellis Scott J, Chan Jeremy Y, Do Huong T, Deland Jonathan T
机构信息
Hospital for Special Surgery, New York, NY, USA.
Hospital for Special Surgery, New York, NY, USA
出版信息
Foot Ankle Int. 2015 Aug;36(8):919-27. doi: 10.1177/1071100715576918. Epub 2015 May 6.
BACKGROUND
While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes.
METHODS
Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II adult-acquired flatfoot deformity (AAFD) by 2 fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and el-Khoury.(23) Changes in pre- and postoperative scores in each Foot and Ankle Outcome Score (FAOS) subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n = 18), mild varus (>0 to 5 mm varus, n = 17), and moderate varus (>5 mm varus, n = 20). Analysis of variance and post hoc Tukey's tests were used to compare the change in FAOS results between these 3 groups.
RESULTS
At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS Pain subscale compared with patients in valgus (P = .04) and the Symptoms subscale compared with patients in moderate varus (P = .03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found.
CONCLUSIONS
Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD.
LEVEL OF EVIDENCE
Level III, comparative series.
背景
虽然先前的研究已经表明跟骨内移截骨术（MCO）的量与重建后影像学上后足对线的变化之间存在线性关系，但尚未有关于理想术后后足对线的报道。本研究的目的是通过将影像学对线与患者预后相关联，确定最佳的术后后足对线。
方法
55例患者的55只足由2名接受过专科培训的足踝整形外科医生进行了II期成人获得性平足畸形（AAFD）的扁平足重建。后足对线如先前Saltzman和el-Khoury所描述的那样确定。(23) 计算术后后足外翻（外翻≥0 mm，n = 18）、轻度内翻（内翻>0至5 mm，n = 17）和中度内翻（内翻>5 mm，n = 20）患者各足踝结果评分（FAOS）子量表术前和术后评分的变化。采用方差分析和事后Tukey检验比较这3组之间FAOS结果的变化。
结果
术后22个月或更长时间，与外翻患者相比，矫正至轻度后足内翻的患者在FAOS疼痛子量表上的改善明显更大（P = .04），与中度内翻患者相比，在症状子量表上的改善明显更大（P = .03）。虽然轻度后足内翻在其他子量表上与中度内翻或外翻没有显著差异，但在任何FAOS子量表上，轻度后足内翻的表现都不比这些对线情况差。未发现术中MCO滑动距离与FAOS子量表之间存在统计学上的显著相关性。
结论
我们的研究表明，在II期扁平足重建后，后足对线视图上后足对线矫正至内翻0至5 mm（临床上足跟笔直）与II期AAFD后足重建的临床结果改善最大相关。
证据水平
III级，比较系列研究。
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