Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore.
Arch Orthop Trauma Surg. 2021 May;141(5):761-773. doi: 10.1007/s00402-020-03458-8. Epub 2020 May 6.
Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis, no other published literature has aimed to review the outcomes in paediatric patients since 2010. This systematic review and meta-analysis, therefore, aims to evaluate the current outcomes of subtalar arthroereisis in the treatment of symptomatic pes planus among the paediatric population.
The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reported on the clinical outcomes of subtalar arthroereisis in children aged 21 or younger were included.
A total of 17 publications were included, with 1536 feet. The average duration of follow-up of the studies included in the review is 43.52 months. The studies consistently reported improvement in the radiological outcomes, approximating that of a normal population. Subtalar arthroereisis has shown to restore the collapsed medial longitudinal arch, supported by the decrease in Meary's angle to 5.267° (95% CI: 4.695°-5.839°, normal: 0°-10.0°) post-operatively and an increased calcaneal pitch of 15.70° (95% CI: 15.41°-15.99°, normal 18.0°-20.0°). Deformities associated with pes planus such as heel valgus was also significantly reduced, evident by the post-operative lateral talocalcaneal angle of 27.19° (95% CI: 26.44°-27.93°, normal: 25.0°-45.0°) and a post-operative Kite's angle of 18.13° (95% CI: 17.73°-18.52°, normal: 15.0°-30.0°). Subjectively, subtalar arthroereisis has generally resulted in an improvement in the grading of outcomes postoperatively from the patient's point of view.
Subtalar arthroereisis could serve as a procedure to correct radiological abnormalities, as well as relieve pain in selected patients with symptomatic pes planus.
距下关节融合术作为治疗有症状的平足症的一种方法，已逐渐被广泛接受。然而，尽管距下关节融合术最近有了新的发展，但自 2010 年以来，没有其他已发表的文献旨在回顾儿科患者的治疗结果。因此，本系统回顾和荟萃分析旨在评估距下关节融合术在治疗儿童有症状的平足症中的当前结果。
本研究采用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。所有报告了儿童接受距下关节融合术治疗的临床结果的研究都被纳入。
共纳入 17 项研究，共 1536 只脚。纳入研究的平均随访时间为 43.52 个月。研究一致报告了放射学结果的改善，接近正常人群。距下关节融合术已被证明可以恢复塌陷的内侧纵弓，Meary 角术后降低至 5.267°（95%可信区间：4.695°-5.839°，正常：0°-10.0°），跟骨倾斜度增加 15.70°（95%可信区间：15.41°-15.99°，正常：18.0°-20.0°）。平足症相关的畸形，如跟外展也显著减少，术后外侧距跟骨角为 27.19°（95%可信区间：26.44°-27.93°，正常：25.0°-45.0°）和术后 Kite 角为 18.13°（95%可信区间：17.73°-18.52°，正常：15.0°-30.0°）证实了这一点。主观上，距下关节融合术一般可改善患者术后的治疗效果分级。
距下关节融合术可作为一种治疗有症状的平足症的方法，纠正放射学异常，并缓解疼痛。
