Tao Xu, Chen Wan, Tang Kanglai
Department of Orthopedic Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
J Orthop Surg Res. 2019 Feb 21;14(1):62. doi: 10.1186/s13018-019-1094-0.
Adult acquired flatfoot deformity (AAFD) represents a spectrum of deformities affecting the foot and the ankle. The optimal management of AAFD remains controversial. We evaluated the efficacy of surgical treatments of AAFD using both direct and indirect evidences.
We searched PubMed, EmBase, and the Cochrane Library to identify eligible studies conducted through November 2018. To compare different surgical strategies, we performed a network meta-analysis. A traditional meta-analysis using a random-effects model was used to evaluate the pooled outcome.
A total of 21 studies including 498 patients were collected and analyzed. Network meta-analysis results based on lateral angle talocalcaneal-calcaneal pitch (LAT-CP) indicated that medial displacement calcaneal osteotomy (MDCO) has the highest probability to be the best course of AAFD treatment. However, analyses based on anteroposterior talo-first metatarsal (AP-TMT1) and lateral angle talocalcaneal talo-first metatarsal (LAT-TMT1) suggested that lateral column lengthening (LCL) was the best treatment, while those based on lateral angle talocalcaneal-arch height, anteroposterior talocalcaneal (AP-TC), lateral angle talocalcaneal-talocalcaneal (LAT-TC), anteroposterior-talonavicular coverage (AP-TNC), talonavicular coverage (TNC), and the American Orthopedic Foot and Ankle Society (AOFAS) indicated triple arthrodesis (TAO) as the best treatment. Moreover, double arthrodesis (DAO) provided the best treatment effect on the function score. Furthermore, according to traditional meta-analysis, the summary of standardized mean differences (SMD) indicated that the surgical interventions are associated with significant improvements in LAT-CP (SMD - 1.78), LAT-arch height (SMD - 4.95), AOFAS (SMD - 5.24), AP-TMT1 (SMD 2.45), LAT-TMT1 (SMD 1.97), AP-TC (SMD 3.05), LAT-TC (SMD 2.20), AP-TNC (SMD 2.07), TNC (SMD 1.70), and function score (SMD 0.95).
Our findings indicated that MDCO, LCL, TAO, or DAO might be the best surgical approaches for AAFD treatment. Furthermore, patients who received surgical interventions had significant improvements in symptoms and function.
成人获得性平足畸形（AAFD）代表了一系列影响足和踝的畸形。AAFD的最佳治疗方法仍存在争议。我们使用直接和间接证据评估了AAFD手术治疗的疗效。
我们检索了PubMed、EmBase和Cochrane图书馆，以确定截至2018年11月进行的符合条件的研究。为了比较不同的手术策略，我们进行了网络荟萃分析。使用随机效应模型的传统荟萃分析来评估汇总结果。
共收集并分析了21项研究，包括498例患者。基于跟骨-距骨外侧角-跟骨倾斜度（LAT-CP）的网络荟萃分析结果表明，内侧移位跟骨截骨术（MDCO）最有可能是AAFD治疗的最佳方案。然而，基于距骨-第一跖骨前后位（AP-TMT1）和跟骨-距骨外侧角-距骨-第一跖骨（LAT-TMT1）的分析表明，外侧柱延长术（LCL）是最佳治疗方法，而基于跟骨-距骨外侧角-足弓高度、跟骨-距骨前后位（AP-TC）、跟骨-距骨外侧角-跟骨-距骨（LAT-TC）、距骨-舟骨前后位覆盖（AP-TNC）、舟骨覆盖（TNC）以及美国矫形足踝协会（AOFAS）的分析表明三关节融合术（TAO）是最佳治疗方法。此外，双关节融合术（DAO）在功能评分方面提供了最佳治疗效果。此外，根据传统荟萃分析，标准化均数差（SMD）汇总表明，手术干预与LAT-CP（SMD -1.78）、LAT-足弓高度（SMD -4.95）、AOFAS（SMD -5.24）、AP-TMT1（SMD 2.45）、LAT-TMT1（SMD 1.97）、AP-TC（SMD 3.05）、LAT-TC（SMD 2.20）、AP-TNC（SMD 2.07）、TNC（SMD 1.70）和功能评分（SMD 0.95）的显著改善相关。
我们的研究结果表明，MDCO、LCL、TAO或DAO可能是AAFD治疗的最佳手术方法。此外，接受手术干预的患者在症状和功能方面有显著改善。
