1 Hospital for Special Surgery, New York, NY, USA.
2 Georgetown University School of Medicine, Washington, DC, USA.
Foot Ankle Int. 2019 May;40(5):491-498. doi: 10.1177/1071100718822839. Epub 2019 Jan 18.
Residual supination of the midfoot during reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) is often addressed with a medial cuneiform (Cotton) osteotomy after adequate correction of the hindfoot valgus deformity. The purpose of this study was to determine if there was a correlation between postoperative alignment of the medial cuneiform and patient-reported outcomes.
Sixty-three feet in 61 patients with stage II AAFD who underwent a Cotton osteotomy as part of a flatfoot reconstruction were included in the study. Radiographic angles were measured on weightbearing lateral radiographs at a minimum of 40 weeks postoperatively. Pearson's correlation analysis was used to determine if there was an association between postoperative radiographic angles and Foot and Ankle Outcome Score (FAOS) at a minimum of 24 months postoperatively. Patients were also divided into mild plantarflexion (cuneiform articular angle [CAA] ≥-2 degrees) and moderate plantarflexion (CAA <-2 degrees) groups to evaluate for differences in clinical outcomes.
Postoperative CAA was significantly positively correlated with the postoperative FAOS symptoms ( r = .27, P = .03), daily activities ( r = .29, P = .02), sports activities ( r = .26, P = .048), and quality of life ( r = .28, P = .02) subscales. Patients in the mild plantarflexion group had statistically and clinically better outcomes compared with the moderate plantarflexion group in the FAOS symptoms ( P = .04), daily activities ( P = .04), and sports activities ( P = .01) subscales.
Our study suggests that the surgeon should avoid excessive plantarflexion of the medial cuneiform and use the Cotton osteotomy judiciously as part of a flatfoot reconstruction for stage II AAFD.
Level III, comparative series.
在重建 II 期成人获得性扁平足畸形（AAFD）时，中足的残余旋后通常通过内侧楔骨（Cotton）截骨术来解决，前提是足后足外翻畸形得到充分矫正。本研究的目的是确定内侧楔骨术后对线与患者报告的结果之间是否存在相关性。
本研究纳入了 61 名患者的 63 只脚，这些患者患有 II 期 AAFD，在接受扁平足重建时接受了 Cotton 截骨术。术后至少 40 周时，在负重侧位 X 光片上测量放射角度。使用 Pearson 相关分析来确定术后放射角度与足踝结果评分（FAOS）之间是否存在关联，FAOS 测量时间至少为术后 24 个月。患者还分为轻度跖屈（楔骨关节角 [CAA]≥-2 度）和中度跖屈（CAA <-2 度）组，以评估临床结果的差异。
术后 CAA 与术后 FAOS 症状（ r =.27，P =.03）、日常活动（ r =.29，P =.02）、运动活动（ r =.26，P =.048）和生活质量（ r =.28，P =.02）呈显著正相关。在 FAOS 症状（ P =.04）、日常活动（ P =.04）和运动活动（ P =.01）方面，轻度跖屈组患者的结果明显优于中度跖屈组。
我们的研究表明，外科医生在重建 II 期 AAFD 时应避免内侧楔骨过度跖屈，并谨慎使用 Cotton 截骨术。
III 级，对比系列。
