Giannini Sandro, Cadossi Matteo, Mazzotti Antonio, Persiani Valentina, Tedesco Giuseppe, Romagnoli Matteo, Faldini Cesare
Professor Emeritus, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):776-782. doi: 10.1053/j.jfas.2017.02.018.
Arthroereisis of the subtalar joint is a common surgical technique in Europe for the management of flexible flatfoot in the pediatric population. In most cases, it is performed using a calcaneo-stop metallic screw. Despite the good clinical results, screw removal is always advised after 2 to 3 years. The use of a bioabsorbable screw might overcome the need for a second operation to remove a nonabsorbable device. We report the results of a biodegradable calcaneo-stop screw at a minimum of 4 years of follow-up. Eighty-eight procedures were performed on 44 children. All patients were clinically and radiologically evaluated preoperatively and at a minimum 4-year follow-up period. Patient satisfaction and plantar collapse using Viladot's classification were recorded. Meary's talus-first metatarsal angle and talocalcaneal angle were measured on radiographs preoperatively and at the last follow-up visit. The presence of the device at the last follow-up examination was assessed by magnetic resonance imaging. The mean follow-up duration was 56 months. Of the 44 patients, 33 (75%) reported excellent clinical outcomes, 9 (20.5%) good outcomes, and 2 (4.5%) poor. Foot print improvement was registered for all patients. The mean Meary's talus-first metatarsal angle had improved from 160.6° ± 7.7° preoperatively to 170.6° ± 6.5° at the last follow-up visit (p < .001). The talocalcaneal angle had decreased from 39.9° ± 5.2° preoperatively to 29.4° ± 4° at the last follow-up examination (p < .001). At the 4-year follow-up point, the implant could be seen to have almost completely biodegraded on magnetic resonance imaging. Two screw breakages occurred. The bioabsorbable calcaneo-stop screw seems to be an effective solution for flexible flatfoot in pediatric patients. Also, owing to its biodegradable composition, the need of a second operation for implant removal will not always be necessary.
距下关节制动术是欧洲治疗儿童柔韧性扁平足的一种常用外科技术。在大多数情况下，该手术使用跟骨制动金属螺钉。尽管临床效果良好，但通常建议在2至3年后取出螺钉。使用可生物吸收螺钉可能无需进行二次手术来取出不可吸收的装置。我们报告了一种可生物降解跟骨制动螺钉至少4年的随访结果。对44名儿童进行了88次手术。所有患者在术前及至少4年的随访期均进行了临床和影像学评估。记录患者满意度以及使用维拉多特分类法评估的足底塌陷情况。术前及最后一次随访时通过X线片测量梅里距骨-第一跖骨角和距跟角。通过磁共振成像评估最后一次随访检查时装置的存在情况。平均随访时间为56个月。44例患者中，33例（75%）报告临床效果极佳，9例（20.5%）效果良好，2例（4.5%）效果较差。所有患者的足迹均有改善。梅里距骨-第一跖骨角的平均值从术前的160.6°±7.7°改善至最后一次随访时的170.6°±6.5°（p<0.001）。距跟角从术前的39.9°±5.2°降至最后一次随访检查时的29.4°±4°（p<0.001）。在4年随访时，磁共振成像显示植入物几乎已完全生物降解。发生了2例螺钉断裂。可生物吸收跟骨制动螺钉似乎是治疗儿童柔韧性扁平足的有效解决方案。此外，由于其可生物降解的成分，不一定总是需要进行二次手术来取出植入物。
