Dussa Chakravarthy U, Döderlein Leonhard, Forst Raimund, Böhm H, Fujak Albert
1 Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany.
2 Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bavaria, Germany.
Foot Ankle Int. 2017 Sep;38(9):1011-1019. doi: 10.1177/1071100717709577. Epub 2017 Jun 6.
Equinovalgus deformity is the second most common deformity in cerebral palsy and may be flexible or rigid. Several operative methods from joint sparing to arthrodesis have been described with varying success rates. The aim of this study was to investigate the effectiveness of naviculectomy in combination with midfoot arthrodesis (talo-cuneiform and calcaneocuboid arthrodesis) in the correction of a rigid equinovalgus foot deformity in cerebral palsy.
Forty-eight rigid equinovalgus feet were operated upon in 30 patients from 2008 to 2013. Of these, 44 feet in 26 patients with cerebral palsy (Gross Motor Function Classification System III, IV, or V) with follow-up of more than 2 years were included in the study. The mean age at surgery was 18.1 years. The outcomes were measured objectively using radiographic angles and subjectively using 5 questions to be answered by the caregiver. The feet were then graded into excellent, good, fair, and poor. The mean follow-up was 5.0 ± 1.7 years.
Excellent to good results were obtained in 81% of the feet. Both objective and subjective outcomes improved significantly postoperatively ( P < .001). Three feet in 2 patients were graded as poor and underwent a revision operation for pain and recurrence.
Naviculectomy in combination with midfoot arthrodesis enabled a good 3-dimensional correction of the forefoot. However, the procedure did not necessarily correct the fixed subtalar joint deformity. Several additional bony and soft-tissue procedures were necessary to achieve a complete correction in these difficult feet.
Level IV, retrospective case series.
马蹄外翻畸形是脑瘫中第二常见的畸形，可为柔性或刚性。已经描述了从保留关节到关节融合的几种手术方法，成功率各不相同。本研究的目的是探讨舟骨切除术联合中足关节融合术（距骨-楔骨和跟骰关节融合术）矫正脑瘫刚性马蹄外翻足畸形的有效性。
2008年至2013年，对30例患者的48只刚性马蹄外翻足进行了手术。其中，对26例脑瘫患者（粗大运动功能分类系统III、IV或V级）的44只足进行了随访，随访时间超过2年，并纳入研究。手术时的平均年龄为18.1岁。使用X线角度进行客观测量，使用5个问题由护理人员进行主观测量。然后将足部分为优、良、中、差四个等级。平均随访时间为5.0±1.7年。
81%的足部获得了优至良的结果。客观和主观结果术后均有显著改善（P<.001）。2例患者的3只足被评为差，并因疼痛和复发接受了翻修手术。
舟骨切除术联合中足关节融合术能够对前足进行良好的三维矫正。然而，该手术不一定能矫正固定的距下关节畸形。对于这些复杂的足部，需要额外的一些骨和软组织手术来实现完全矫正。
IV级，回顾性病例系列。
