1 Georgetown University School of Medicine, Washington, DC, USA.
2 Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2018 Aug;39(8):885-893. doi: 10.1177/1071100718768020. Epub 2018 Apr 5.
Background Residual forefoot supination after correcting the hindfoot in stage IIb adult-acquired flatfoot deformity can be addressed with a dorsal opening wedge medial cuneiform (Cotton) osteotomy. The amount of correction is generally judged clinically, and there currently are no preoperative guides that can predict the size of graft needed. The aim of this study was to evaluate the correlation between patient and operative factors and the correction achieved with the Cotton osteotomy.
Seventy-nine feet in 74 patients undergoing Cotton osteotomy as part of flatfoot reconstruction were reviewed retrospectively. Preoperative and minimum 40-week postoperative lateral foot weightbearing radiographs were compared to assess correction of longitudinal arch collapse as measured by 13 radiographic parameters, with particular emphasis on the cuneiform articular angle (CAA). Additional demographic and intraoperative variables analyzed for association with radiographic change included age, gender, body mass index, amounts and graft types of Cotton osteotomy and lateral column lengthening, and amount of medializing calcaneal osteotomy. A multivariate linear regression model was developed for each variable found to be significant in univariate analysis.
The Cotton osteotomy graft size was significantly associated with changes in the CAA ( P < .001), calcaneal pitch ( P = .03), lateral talonavicular Cobb angle ( P = .03), and lateral naviculomedial cuneiform Cobb angle ( P = .03). The Cotton graft size was the only factor found to significantly predict a change in the CAA in the final linear regression model ( P < .001, R = 0.27), with each millimeter of Cotton corresponding to a 2.1-degree decrease of the CAA.
Correction of longitudinal arch collapse, as measured by the CAA, was primarily influenced by the size of the graft used for the Cotton osteotomy in a linear fashion. The preoperative CAA may help surgeons titrate the proper amount of graft placed intraoperatively.
Level IV, Retrospective Case Series.
在成人获得性扁平足畸形 IIb 期纠正后足畸形后，残留前足旋后可通过背侧开放楔形内侧楔骨（Cotton）截骨术解决。通常通过临床判断矫正程度，目前尚无术前指南可以预测所需移植物的大小。本研究旨在评估患者和手术因素与 Cotton 截骨术矫正程度之间的相关性。
回顾性分析 74 例患者的 79 足接受 Cotton 截骨术作为扁平足重建的一部分。比较术前和至少 40 周的术后侧位足部负重 X 线片，以评估 13 个 X 线参数测量的后足纵弓塌陷的矫正情况，特别强调楔骨关节角（CAA）。分析与 X 线变化相关的其他人口统计学和术中变量，包括年龄、性别、体重指数、Cotton 截骨和外侧柱延长的数量和移植物类型以及内侧化跟骨截骨的数量。对单变量分析中发现有统计学意义的每个变量进行多元线性回归模型分析。
Cotton 截骨术移植物大小与 CAA（P <.001）、跟骨倾斜角（P =.03）、外侧距舟状骨 Cobb 角（P =.03）和外侧舟状骨-内侧楔骨 Cobb 角（P =.03）的变化显著相关。在最终的线性回归模型中，Cotton 移植物大小是唯一显著预测 CAA 变化的因素（P <.001，R = 0.27），每毫米 Cotton 移植物对应 CAA 降低 2.1 度。
CAA 测量的后足纵弓塌陷矫正主要受 Cotton 截骨术中使用的移植物大小的线性影响。术前 CAA 可能有助于外科医生术中调整适当的移植物量。
IV 级，回顾性病例系列。
