Caravaggi Paolo, Lullini Giada, Berti Lisa, Giannini Sandro, Leardini Alberto
Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
First Orthopaedics and Traumatology Clinic, Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, Bologna, Italy.
Gait Posture. 2018 Jul;64:152-158. doi: 10.1016/j.gaitpost.2018.06.023. Epub 2018 Jun 11.
Flexible flatfoot (FFF) is a common alteration of the foot diagnosed in the pediatric population causing pain and decreased quality of life. Surgical treatment via arthroereisis of the subtalar joint can be recommended when non-invasive options do not result in sufficient pain relief. While clinical outcome of subtalar joint arthroereisis is generally positive, no functional evaluation has thus far been reported following surgery.
The aim of this study was to assess the effects of two arthroereisis implants for the correction of bilateral FFF on foot and lower limb biomechanics during gait.
This is a prospective study following 13 children affected by bilateral symptomatic FFF. The patients underwent bilateral subtalar arthroereisis during the same surgery using two types of poly-L-lactide bioabsorbable implants: an expanding endo-orthotic implant, and a calcaneo-stop screw. Radiological parameters and gait analysis were performed preoperatively and at 1 year follow-up and compared to those from an age-matched normal-arched control population. Lower limb and multisegment foot kinematic analysis, along with EMG of the main ankle flexor/extensor muscles, were performed during level walking at comfortable speed. Paired non-parametric Wilcoxon signed-rank test was used to assess differences in radiological and kinematic parameters between pre-op and post-op assessments.
All radiological parameters, and frontal-plane orientation of the rearfoot in double-leg standing were improved at 1-year follow-up in both implant groups (e.g calcaneo-stop: pre-op = 15 ± 7 deg; post-op = 6 ± 9 deg; p < 0.01). The endo-orthotic implant group showed significantly lower pronation/supination at the ankle and midtarsal joint. Activation of the tibialis anterior muscle was more physiological after surgery in both groups.
According to the present analysis, both implants appear effective in restoring physiological alignment of the rearfoot, however the endo-orthotic implant appeared more effective in restoring a more correct frontal-plane mobility of foot joints.
柔性扁平足（FFF）是儿科人群中常见的足部病变，会导致疼痛并降低生活质量。当非侵入性治疗方法无法充分缓解疼痛时，可推荐通过距下关节制动术进行手术治疗。虽然距下关节制动术的临床效果总体良好，但迄今为止尚未有术后功能评估的报道。
本研究的目的是评估两种用于矫正双侧FFF的距下关节制动植入物对步态期间足部和下肢生物力学的影响。
这是一项对13例双侧有症状FFF患儿的前瞻性研究。患者在同一次手术中接受双侧距下关节制动术，使用两种聚-L-丙交酯生物可吸收植入物：一种可扩张的内置矫形植入物和一枚跟骨止动螺钉。术前及术后1年进行放射学参数和步态分析，并与年龄匹配的正常足弓对照人群进行比较。在舒适速度下进行平地行走时，进行下肢和多节段足部运动学分析，以及主要踝关节屈伸肌的肌电图检查。采用配对非参数Wilcoxon符号秩检验评估术前和术后放射学及运动学参数的差异。
两个植入物组在术后1年时，所有放射学参数以及双腿站立时后足在额状面的方向均得到改善（例如跟骨止动螺钉组：术前=15±7度；术后=6±9度；p<0.01）。内置矫形植入物组在踝关节和中跗关节处的内旋/外旋明显更低。两组术后胫骨前肌的激活更接近生理状态。
根据目前的分析，两种植入物在恢复后足的生理对线方面似乎都有效，然而内置矫形植入物在恢复足部关节更正确的额状面活动度方面似乎更有效。
