Cao Le, Miao Xu-Dong, Wu Yong-Ping, Zhang Xiang-Feng, Zhang Qiang
Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Orthop Surg. 2017 Feb;9(1):20-27. doi: 10.1111/os.12309.
To evaluate the therapeutic outcomes with Kalix II subtalar arthroereisis in sinus tarsi for juvenile flexible flatfoot.
A retrospective analysis of the data of 20 juveniles with symptomatic flexible flatfoot (27 feet) who underwent the Kalix II implant procedure from January 2008 to September 2012 was performed. The pain during daily activities was assessed and followed up by use of a standard 10-point visual analog scale (VAS), and function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, and anteroposterior talar-first metatarsal angle, lateral talar-first metatarsal angle, calcaneal pitch angle, and talar declination angle at X-ray film were measured to assess the therapeutic outcomes. Patients were asked to grade the result of the procedure as excellent, good, fair, or poor at latest follow-up. The data was expressed as mean ± standard deviation (SD). A paired Student's t -test was used for comparisons of the preoperative and postoperative angular measurements for each foot, VAS scores, and AOFAS scores. In all tests, P < 0.05 was considered statistically significant.
The mean age of the patients was 12.1 years (range, 7-16 years), and 16 left feet and 11 right feet were involved. All patients finished the follow-up with a mean period of 28.1 months (range, 23-60 months). Eleven feet were treated with subtalar arthroereisis combined with reconstruction of the end point of the posterior tibialis tendon after dissection of the accessory scaphoid. The subtalar arthroereisis device displaced in 1 foot due to a fall from the inversion position 3 months after surgery, and was replaced by a new device after the failure of conservative treatment. The mean VAS score decreased from 5.6 ± 0.5 preoperatively to 1.2 ± 0.2 (P < 0.001), and the mean AOFAS hindfoot and ankle score improved from 71.1 ± 6.1 preoperatively to 88.1 ± 6.3 (P < 0.001). Differences between preoperative and postoperative measurements for each radiographic variable were statistically significant (P < 0.001). Comparison of radiographic measurements showed that the anteroposterior talar-first metatarsal (Meary) angle decreased by a mean of 12.8° ± 1.5°, the lateral talar-first metatarsal (Meary) angle decreased by a mean of 15.4° ± 1.3°, the calcaneal pitch angle increased by a mean of -2.1° ± 0.7°, and the talar declination angle decreased by a mean of 17.9° ± 2.8°. Overall, 12 patients rated the result as excellent, 6 as good, and 2 as fair.
The application of Kalix II in subtalar arthroereisis combined with dissection of accessory scaphoid and reconstruction of posterior tibialis tendon is an effective therapy for flexible juvenile flatfoot.
评估Kalix II距下关节制动术治疗青少年柔韧性扁平足的疗效。
对2008年1月至2012年9月期间接受Kalix II植入手术的20例有症状的柔韧性扁平足青少年（27足）的数据进行回顾性分析。采用标准的10分视觉模拟量表（VAS）评估日常活动中的疼痛情况并进行随访，使用美国矫形足踝协会（AOFAS）踝与后足评分系统评估功能，并测量X线片上的距骨-第一跖骨角、外侧距骨-第一跖骨角、跟骨倾斜角和距骨倾斜角以评估治疗效果。在最近一次随访时，要求患者将手术结果评为优、良、中或差。数据以均数±标准差（SD）表示。采用配对t检验比较每只足术前和术后的角度测量值、VAS评分和AOFAS评分。在所有检验中，P < 0.05被认为具有统计学意义。
患者的平均年龄为12.1岁（范围7 - 16岁），涉及16只左脚和11只右脚。所有患者均完成随访，平均随访时间为28.1个月（范围23 - 60个月）。11只足在切除副舟骨后行距下关节制动术并重建胫后肌腱止点。1只足在术后3个月因从内翻位摔倒导致距下关节制动装置移位，保守治疗失败后更换为新装置。VAS评分的均值从术前的5.6±0.5降至1.2±0.2（P < 0.001），AOFAS后足与踝评分的均值从术前的71.1±6.1提高到88.1±6.3（P < 0.001）。每个影像学变量术前和术后测量值的差异具有统计学意义（P < 0.001）。影像学测量值比较显示，距骨-第一跖骨（Meary）角平均减小12.8°±1.5°，外侧距骨-第一跖骨（Meary）角平均减小15.4°±1.3°，跟骨倾斜角平均增加-2.1°±0.7°，距骨倾斜角平均减小17.9°±2.8°。总体而言，12例患者将结果评为优，6例评为良，2例评为中。
Kalix II应用于距下关节制动术联合副舟骨切除及胫后肌腱重建是治疗青少年柔韧性扁平足的有效方法。
