Zaghloul Khaled M, Saied Ahmed Mostafa, Abouelnas Bassam A, Al Adl Wael Ali M
Department of Orthopedic, Mansoura University, Mansoura University Hospital, Mansoura, Egypt.
J Pediatr Orthop B. 2019 Nov;28(6):598-601. doi: 10.1097/BPB.0000000000000658.
A structural graft is often used to maintain correction and achieve union after anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot. Autograft, the current gold standard, is limited in availability and configuration and is associated with donor site morbidity in as much as 48%, whereas the alternative allograft carries risks of disease transmission and collapse. Polyaryletherketone cage, with a healing rate similar to that of autograft, high stability, and no donor-site morbidity, has been used in spine surgery. However, its use has not been documented in foot and ankle surgery. We reviewed 15 patients with painful flatfeet after failure of conservative treatment who were treated by anterior calcaneal lengthening osteotomy using polyaryletherketone cage instead of bone graft. Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). The male-female ratio was 1:1.5 (six males, nine females). Mean age at time of surgery was 10.8 ± 1.7 years (range, 8-13.5 years). Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). Nine patients had a unilateral procedure and three had a simultaneous bilateral procedure, for a total of 15 operated feet (seven right and eight left). The paired t-test result was statistically significant in comparison of radiographic measurements at presurgery and postsurgery with P value <0.001. All cases showed full union clinically and radiographically at last follow-ups and no complications occurred. Our data suggest that polyaryletherketone cage may be used as a structural graft option for anterior calcaneal lengthening osteotomy.
在采用跟骨前部延长截骨术治疗柔韧性扁平足时，常使用结构性移植物来维持矫正效果并实现骨愈合。自体骨移植作为当前的金标准，在可用性和形态方面存在局限，且供区并发症发生率高达48%，而异体骨移植则存在疾病传播和塌陷的风险。聚芳醚酮融合器的愈合率与自体骨相似，稳定性高，且无供区并发症，已应用于脊柱手术。然而，其在足踝外科手术中的应用尚无相关文献记载。我们回顾了15例保守治疗失败后出现疼痛性扁平足的患者，这些患者接受了使用聚芳醚酮融合器而非骨移植的跟骨前部延长截骨术。最短随访时间为1年（平均1.27年；范围1 - 1.5年）。男女比例为1:1.5（6例男性，9例女性）。手术时的平均年龄为10.8 ± 1.7岁（范围8 - 13.5岁）。最短随访时间为1年（平均1.27年；范围1 - 1.5年）。9例患者接受了单侧手术，3例患者同时接受了双侧手术，共计15只手术足（7只右侧，8只左侧）。术前和术后影像学测量结果的配对t检验具有统计学意义，P值<0.001。所有病例在最后一次随访时临床和影像学检查均显示完全愈合，且未发生并发症。我们的数据表明，聚芳醚酮融合器可作为跟骨前部延长截骨术的一种结构性移植物选择。
