Kubo H, Krauspe R, Hufeland M, Lipp C, Ruppert M, Westhoff B, Pilge H
University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf, Germany.
J Child Orthop. 2019 Aug 1;13(4):346-352. doi: 10.1302/1863-2548.13.190046.
Therapy of juvenile neurogenic flatfoot (JNF) with subtalar arthroereisis (SA) is currently under critical clinical investigation. In this retrospective matched pair analysis, the radiological outcome after arthroereisis in paediatric patients with infantile cerebral palsy and JNF was compared with children with juvenile flatfeet (JF) without neurological diseases.
From October 2007 to April 2018 80 patients with 149 flatfeet underwent surgery with SA. Inclusion criteria were: 1) JNF or JF with age at surgery ≤ 13 years; 2) treatment with SA; 3) presence of three sets of biplane radiographs (preoperative, postoperative and follow-up (FU)). The radiographs were analyzed for: 1) navicular-cuboidal-index (NCI); 2) talocalcaneal angle anteroposterior; 3) talocalcaneal angle lateral; 4) calcaneal-pitch (CP); and 5) talometatarsal-index (TMTI). Following this, 25 patients with 38 flatfeet could be included.
The mean age at SA of the JNF group was 9.2 years (JF group: 9.3 years) and the mean time of FU was 35.2 months (JF group: 39.4 months). In comparison with preoperatively, a significant decrease of the NCI was seen in both groups (p = ≤ 0.05 and p = ≤ 0.001) in the FU radiographs. The analysis of CP and TMTI in the JF group also resulted in a significant improvement (p = ≤ 0.001 and p = ≤ 0.05). Overall, the comparison between the JNF and JF group showed no significant differences in regard to the analyzed postoperative parameters.
Based on this data, treatment of flatfeet by SA in patient with neurological disorders shows an improvement of radiological parameters comparable with neurologically unimpaired patients and might be considered as additional treatment option.
IV.
距下关节制动术（SA）治疗青少年神经源性扁平足（JNF）目前正处于关键的临床研究阶段。在这项回顾性配对分析中，对患有婴儿脑性瘫痪和JNF的儿科患者进行关节制动术后的放射学结果与无神经疾病的青少年扁平足（JF）儿童进行了比较。
2007年10月至2018年4月，80例患者共149只扁平足接受了SA手术。纳入标准为：1）手术时年龄≤13岁的JNF或JF；2）采用SA治疗；3）有三组双平面X线片（术前、术后和随访（FU））。对X线片分析以下指标：1）舟骰指数（NCI）；2）距跟前后角；3）距跟外侧角；4）跟骨倾斜度（CP）；5）距跖指数（TMTI）。之后，纳入了25例患者共38只扁平足。
JNF组SA时的平均年龄为9.2岁（JF组：9.3岁），平均随访时间为35.2个月（JF组：39.4个月）。与术前相比，两组在随访X线片中NCI均显著降低（p≤0.05和p≤0.001）。JF组CP和TMTI分析也有显著改善（p≤0.001和p≤0.05）。总体而言，JNF组和JF组之间在分析的术后参数方面无显著差异。
基于这些数据，SA治疗神经疾病患者的扁平足，其放射学参数的改善与神经功能未受损患者相当，可被视为一种额外的治疗选择。
IV级
