Cho Byung Chae, Lee In Hyeok, Chung Chin Youb, Sung Ki Hyuk, Lee Kyoung Min, Kwon Soon-Sun, Moon Seung Jun, Kim Jaeyoung, Lim Hyunwoo, Park Moon Seok
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital.
Department of Orthopaedic Surgery, Bumin Hospital, Seoul, Korea.
J Pediatr Orthop B. 2018 May;27(3):206-213. doi: 10.1097/BPB.0000000000000436.
Calcaneal lengthening (CL) is one of the treatment options for planovalgus deformity in patients with cerebral palsy (CP). However, its indication still needs to be clarified according to the functional status of CP. The aim of this study was to investigate the radiographic outcome after CL in patients with CP and to evaluate the risk factors causing undercorrection of planovalgus deformities. We included consecutive patients with CP who underwent CL for planovalgus deformity, were followed for more than 2 years, and had preoperative and postoperative weight-bearing anteroposterior (AP) and lateral foot radiographs. Six radiographic indices were used to assess the radiographic outcome. The patient age, sex, and Gross Motor Function Classification System (GMFCS) level were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. A total of 44 (77 feet) patients were included in this study. The mean age of the patients at the time of surgery was 10.5±4.0 years and the mean follow-up was 5.1±2.2 years. Patients with GMFCS III/IV achieved less correction than those with GMFCS I/II in the AP talus-first metatarsal angle (P=0.001), lateral talocalcaneal angle (P=0.028), and the lateral talus-first metatarsal angle (P<0.001). The rate of undercorrection in the GMFCS III/IV group was 1.6 times higher than that in the GMFCS I/II group in the AP talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.2-2.0; P<0.001) and 1.6 times higher in the lateral talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.3-1.9; P<0.001). In GMFCS I/II patients with CP, we found CL to be an effective procedure for the correction of planovalgus foot deformities. However, in GMFCS III/IV patients with planovalgus deformities, CL appears to be insufficient on the basis of the high rate of undercorrection in these patients. For patients with GMFCS level III/IV, additional or alternative procedures should be considered to correct the deformity and maintain the correction achieved.
Level III, therapeutic study.
跟骨延长术（CL）是治疗脑瘫（CP）患者扁平外翻畸形的治疗选择之一。然而，其适应症仍需根据CP的功能状态来明确。本研究的目的是调查CP患者CL术后的影像学结果，并评估导致扁平外翻畸形矫正不足的危险因素。我们纳入了因扁平外翻畸形接受CL治疗、随访超过2年且有术前和术后负重前后位（AP）及足部侧位X线片的连续CP患者。使用六个影像学指标评估影像学结果。将患者年龄、性别和粗大运动功能分类系统（GMFCS）水平作为可能的危险因素进行评估，并使用多变量分析控制潜在混杂变量的相互作用。本研究共纳入44例（77足）患者。手术时患者的平均年龄为10.5±4.0岁，平均随访时间为5.1±2.2年。GMFCS III/IV级患者在AP距骨-第一跖骨角（P = 0.001）、外侧距跟角（P = 0.028）和外侧距骨-第一跖骨角（P < 0.001）方面的矫正程度低于GMFCS I/II级患者。GMFCS III/IV级组在AP距骨-第一跖骨角的矫正不足率比GMFCS I/II级组高1.6倍（优势比：1.6；95%置信区间：1.2 - 2.0；P < 0.001），在外侧距骨-第一跖骨角高1.6倍（优势比：1.6；95%置信区间：1.3 - 1.9；P < 0.001）。在GMFCS I/II级的CP患者中，我们发现CL是矫正扁平外翻足畸形的有效方法。然而，在GMFCS III/IV级的扁平外翻畸形患者中，基于这些患者较高的矫正不足率，CL似乎不够充分。对于GMFCS III/IV级患者，应考虑采用额外或替代手术来矫正畸形并维持已取得的矫正效果。
III级，治疗性研究。
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