儿童特发性马蹄内翻足跟腱切断术后外侧距跟角的早期影像学变化。

Early Radiographic Changes in the Lateral Talocalcaneal Angle Following Achilles Tenotomy in Children With Idiopathic Clubfoot.

机构信息

Department of Paediatric Orthopaedics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China.

Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand, France.

出版信息

Foot Ankle Int. 2020 Mar;41(3):350-355. doi: 10.1177/1071100719895211. Epub 2019 Dec 19.

DOI:10.1177/1071100719895211

PMID:31855081

Abstract

BACKGROUND

Percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method and is performed in 85% to 90% of patients. However, there is a lack of objective data assessing early radiographic changes in children undergoing PAT.

METHODS

Forty-nine patients with idiopathic clubfoot treated by Ponseti casting were prospectively enrolled between October 2017 and October 2018. Preoperative and postoperative ankle dorsiflexion (pre-ADF, post-ADF) and lateral talocalcaneal angle (pre-LTCA, post-LTCA) values with the ankle in maximal dorsiflexion as well as postoperative LTCA values with the ankle in the neutral position (post-LTCA) were measured. The relationship between the preoperative and postoperative ADF and LTCA values was studied using Pearson or Spearman correlation coefficients. Forty-nine patients (72 feet) were included; the mean age at initial treatment was 32.2 ± 24.1 days.

RESULTS

Post-LTCA improved significantly from 18.6 ± 9.2 degrees to 25.1 ± 10.5 degrees ( < .0001). Pre-ADF and pre-LTCA showed a positive correlation in both the less than 28-day group ( = 0.42; = .015) and the Dimeglio III group ( = 0.29; = .035). However, post-ADF and post-LTCA showed a positive correlation in the Dimeglio III group ( = 0.30; = .028). The degree of improvement in post-LCTA in the Dimeglio III group was similar to that in the Dimeglio IV group ( = .28).

CONCLUSION

The LTCA increased immediately after PAT in clubfoot, although the improvement seemed to be unrelated to the severity of the disease. PAT led to an increase in both ADF and the LTCA, and it contributed to the improvements in subtalar joint motion and alignment.

LEVEL OF EVIDENCE

Level III, comparative study.

摘要

背景

经皮跟腱切断术（PAT）是潘塞提方法的重要组成部分，在 85%至 90%的患者中进行。然而，目前缺乏评估接受 PAT 治疗的儿童早期放射影像学变化的客观数据。

方法

2017 年 10 月至 2018 年 10 月，前瞻性纳入 49 例采用潘塞提石膏固定治疗的特发性马蹄足患者。在踝关节最大背屈位测量术前和术后踝关节背屈（术前 ADF、术后 ADF）和外侧距跟角（术前 LTCA、术后 LTCA）值，以及踝关节中立位时的术后 LTCA 值（术后 LTCA）。使用 Pearson 或 Spearman 相关系数研究术前和术后 ADF 及 LTCA 值之间的关系。共纳入 49 例患者（72 足），初始治疗时的平均年龄为 32.2±24.1 天。

结果

术后 LTCA 从 18.6°±9.2°显著改善至 25.1°±10.5°（<0.0001）。在小于 28 天组（=0.42；=0.015）和 Dimeglio III 组（=0.29；=0.035）中，术前 ADF 和术前 LTCA 呈正相关。然而，在 Dimeglio III 组中，术后 ADF 和术后 LTCA 呈正相关（=0.30；=0.028）。Dimeglio III 组的术后 LTCA 改善程度与 Dimeglio IV 组相似（=0.28）。