Knapik D M, Archibald H D, Xie K K, Liu R W
Rainbow and Babies Hospital at Case Western Reserve University, Cleveland, Ohio, USA.
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
J Child Orthop. 2019 Feb 1;13(1):107-113. doi: 10.1302/1863-2548.13.180168.
The variables causing symptomatic accessory navicular are largely unknown and may inform management of symptomatic patients. The purpose of this study was to examine patient specific factors associated with the development of accessory navicular symptoms.
A total of 71 patients with clinical and radiographic evidence of accessory navicular syndrome were evaluated. Patient gender, race, date of birth, date of earliest foot complaint and laterality were recorded. Treatment was defined as conservative surgical. Skeletal maturity was assessed based on calcaneal ossification, accessory navicular subtype and the presence of pes planus based on talo-first metatarsal angle were assessed.
Female patients comprised 72% of the subjects and trended towards symptoms at younger ages than male patients (p = 0.06), while no significant difference in presentation age was appreciated between male and female patients. Skeletal maturity was significantly associated with earlier complaints and age at presentation but was not associated with increased need for surgical management. Patients with pes planus were significantly more likely to undergo operative management. Accessory navicular subtype was significantly correlated with skeletal maturity.
Female patients were more likely to report symptoms and present with symptomatic accessory navicular. The stage of skeletal maturity is not a predictor of future surgical management but patients with a higher first-metatarsal angle were more likely to require surgery. The correlation between accessory navicular subtype and skeletal maturity suggests that Type II ossicles are likely to develop into Type III over time. Radiographic evaluation of the accessory navicular may lend prognostic data on the necessity of future surgical intervention.
IV, Case Series.
导致症状性副舟骨的因素在很大程度上尚不明确，这可能为有症状患者的治疗提供依据。本研究的目的是探讨与副舟骨症状发生相关的患者特定因素。
对71例有临床和影像学证据的副舟骨综合征患者进行评估。记录患者的性别、种族、出生日期、最早足部不适日期和患侧。治疗方式定义为保守治疗或手术治疗。根据跟骨骨化情况评估骨骼成熟度，评估副舟骨亚型以及根据距骨-第一跖骨角评估扁平足的存在情况。
女性患者占受试者的72%，且比男性患者在更年轻的年龄出现症状（p = 0.06），而男性和女性患者的发病年龄无显著差异。骨骼成熟度与更早出现不适和发病年龄显著相关，但与手术治疗需求增加无关。扁平足患者接受手术治疗的可能性显著更高。副舟骨亚型与骨骼成熟度显著相关。
女性患者更有可能报告症状并出现症状性副舟骨。骨骼成熟阶段不是未来手术治疗的预测指标，但第一跖骨角较高的患者更有可能需要手术。副舟骨亚型与骨骼成熟度之间的相关性表明，II型小骨随着时间推移可能发展为III型。副舟骨的影像学评估可能为未来手术干预的必要性提供预后数据。
IV，病例系列。
