Walley Kempland C, Greene Gearin, Hallam Jesse, Juliano Paul J, Aynardi Michael C
Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Foot Ankle Spec. 2019 Apr;12(2):122-130. doi: 10.1177/1938640018770242. Epub 2018 Apr 12.
The use of an arthroereisis implant for the treatment of adolescent flatfoot deformity has been described. However, data that address the outcomes of patients treated with an arthroereisis implant in adults are limited. The purpose of this study was to investigate the radiographic and clinical outcomes and complications following the use of a subtalar arthroereisis implant as an adjunct for correction acquired flatfoot deformity secondary to posterior tibial tendon dysfunction.
A retrospective case-control study was performed querying all patients undergoing surgical flatfoot correction between January 1, 2010 and January 1, 2015. The experimental group included patients undergoing arthroereisis augmentation at the time of flatfoot correction. Patients undergoing the same flatfoot correction without the use of an arthroereisis implant were used as controls. Radiographic measurements were evaluated preoperatively and at final radiographic follow-up and included talonavicular (TN) coverage angle, and lateral talar-first metatarsal angle (T1MA). Patient-reported outcomes were assessed using preoperative visual analog scale (VAS) pain scores and postoperative Short Form-36, VAS, and satisfaction at final orthopedic follow-up.
A total of 15 patients underwent flatfoot correction and were augmented with an arthroereisis implant and were matched with 30 controls. Postoperative, mid-term T1MA and regional analysis was found to be improved in the experimental group versus control. Patients undergoing adjunct subtalar arthroereisis demonstrated an increased likelihood of achieving radiographically normal talonavicular coverage <7° compared with our control group at follow-up.
The adjunct use of an arthroereisis implant resulted in improved and maintained radiographic and clinical measurements in patients undergoing stage II flatfoot.
These results suggest utility of a subtalar arthroereisis implant as an adjunct to flatfoot correction with little additional risk of harm to the patient.
Level III: Case-control study.
已有文献描述了使用关节制动植入物治疗青少年扁平足畸形的情况。然而，关于在成人中使用关节制动植入物治疗患者的结果的数据有限。本研究的目的是调查使用距下关节制动植入物作为辅助手段矫正继发于胫后肌腱功能障碍的后天性平足畸形后的影像学和临床结果及并发症。
进行一项回顾性病例对照研究，查询2010年1月1日至2015年1月1日期间所有接受手术性平足矫正的患者。实验组包括在平足矫正时接受关节制动增强术的患者。将接受相同平足矫正但未使用关节制动植入物的患者作为对照组。术前和最终影像学随访时评估影像学测量指标，包括距舟关节（TN）覆盖角和外侧距骨-第一跖骨角（T1MA）。使用术前视觉模拟量表（VAS）疼痛评分以及术后简短健康调查问卷（Short Form-36）、VAS和最终骨科随访时的满意度来评估患者报告的结果。
共有15例患者接受了平足矫正并使用关节制动植入物进行增强，并与30例对照组患者匹配。术后，发现实验组的中期T1MA和区域分析结果相对于对照组有所改善。与对照组相比，接受距下关节制动辅助治疗的患者在随访时达到影像学上距舟关节覆盖正常<7°的可能性增加。
在接受II期平足治疗的患者中，辅助使用关节制动植入物可改善并维持影像学和临床测量结果。
这些结果表明距下关节制动植入物作为平足矫正辅助手段的实用性，且对患者几乎没有额外的伤害风险。
III级：病例对照研究。
