Zhuang Thompson, El-Banna Ghida, Frick Steve
Orthopaedic Surgery, Stanford University, Stanford, USA.
Orthopaedics, Stanford University, Stanford, USA.
Cureus. 2019 Dec 29;11(12):e6505. doi: 10.7759/cureus.6505.
Background Although clubfoot that was corrected in childhood rarely recurs in adulthood, persistent deformities or arthritic pain may require further treatment during adulthood. Little evidence exists on the operative procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood, for residual or recurrent deformity or pain. Objective The objective of this study is to characterize the types and frequencies of procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood. Methods A two-pronged approach was employed to describe the operative procedures used in adult clubfoot patients. First, a literature review of all reported cases of operative treatment in adult clubfoot patients who were previously treated in childhood was performed. Second, an analysis of the operative treatments used in adult patients with a diagnosis of congenital clubfoot was conducted using a large, administrative claims database. Results In the literature review, arthrodesis was the most cited operative treatment and reported in four out of the eight studies included. Osteotomies were also reported in the literature. In the database analysis, 94 hindfoot arthrodesis procedures were identified in 73 patients, out of 1,198 adult patients in the database with a diagnosis of congenital clubfoot. Sixty-two patients out of 1,198 adult clubfoot patients received osteotomies. An insufficient number of total ankle arthroplasties were reported for further analysis. Conclusions Operative treatment in adult clubfoot patients who were treated for congenital clubfoot in childhood includes hindfoot arthrodesis and osteotomy procedures. Total ankle arthroplasty has not been reported in the literature for these patients.
尽管儿童期矫正的马蹄内翻足在成年期很少复发，但持续性畸形或关节炎疼痛可能需要在成年期进行进一步治疗。对于童年时期曾接受先天性马蹄内翻足治疗的成年马蹄内翻足患者，针对残留或复发性畸形或疼痛所采用的手术操作，目前几乎没有相关证据。
本研究的目的是描述童年时期曾接受先天性马蹄内翻足治疗的成年马蹄内翻足患者所采用手术操作的类型和频率。
采用双管齐下的方法来描述成年马蹄内翻足患者所采用的手术操作。首先，对所有报道的童年时期曾接受治疗的成年马蹄内翻足患者手术治疗病例进行文献综述。其次，使用一个大型管理索赔数据库对诊断为先天性马蹄内翻足的成年患者所采用的手术治疗进行分析。
在文献综述中，关节融合术是被引用最多的手术治疗方法，在所纳入的八项研究中有四项报道了该方法。文献中也报道了截骨术。在数据库分析中，在数据库中诊断为先天性马蹄内翻足的1198名成年患者中，73名患者接受了94例后足关节融合术。1198名成年马蹄内翻足患者中有62名接受了截骨术。报道的全踝关节置换术数量不足，无法进行进一步分析。
童年时期曾接受先天性马蹄内翻足治疗的成年马蹄内翻足患者的手术治疗包括后足关节融合术和截骨术。文献中尚未报道这些患者的全踝关节置换术。
