经胫骨前远端干骺端骺阻滞术矫正手术治疗的马蹄内翻足的复发马蹄足畸形。

Correction of Recurrent Equinus Deformity in Surgically Treated Clubfeet by Anterior Distal Tibial Hemiepiphysiodesis.

机构信息

Department of Pediatric Orthopaedics, Altonaer Children's Hospital.

Departments of Orthopaedics.

出版信息

J Pediatr Orthop. 2020 Oct;40(9):520-525. doi: 10.1097/BPO.0000000000001609.

DOI:10.1097/BPO.0000000000001609

PMID:32555046

Abstract

BACKGROUND

Residual or recurrent equinus deformity is a common problem in surgically treated clubfeet. This deformity may occur due to soft tissue-related reasons or due to bony deformity. An increased anterior distal tibial angle (ADTA) was previously found in 48% of the operated clubfeet. This study aimed to determine the efficacy and safety of anterior distal tibial hemiepiphysiodesis (ADTE) in the treatment of recurrent equinus deformity in patients with an increased ADTA.

METHODS

Eighteen children (23 feet) treated by ADTE to correct recurrent equinus deformity in surgically treated clubfeet were included in this retrospective, single-center study. ADTE using 8 plates was performed in children with an increased ADTA (>82 degrees) and inability to dorsiflex the ankle (≤0 degree of dorsiflexion). The mean patient age was 11.3 years (range: 10.2 to 12.9 y). All patients had completed treatment with implant removal after an average of 20.3 months (range: 9 to 37 mo).

RESULTS

The mean preoperative ankle dorsiflexion significantly improved from -3.3 degrees (range: -20 to -0 degrees) to 6.1 degrees (range: -15 to 10 degrees) at the time of 8-plate removal (correction rate: 9.4 degrees; P<0.0001). The ADTA was a mean of 87.5 degrees (range: 83 to 110 degrees) before surgery and significantly improved to 75.8 degrees (range: 63 to 106 degrees) at the time of implant removal (correction rate: 11.7 degrees; P<0.0001). Average follow-up was 43.9 months (range: 10 to 76 mo). Follow-up examinations were continued in 11 patients (13 feet) after implant removal. Changes of ankle dorsiflexion (mean: -2.5 degrees) and ADTA (mean: 3.6 degrees) occurred in this group.

CONCLUSIONS

ADTE was safe and effective in the treatment of recurrent equinus deformity in surgically treated clubfeet with increased ADTA. Deterioration of ankle dorsiflexion and ADTA occurred after implant removal in some cases. The results of this study have to be analyzed with caution due to the limited number of included patients and its retrospective nature.

LEVEL OF EVIDENCE

Level IV-retrospective case series.

摘要

背景

在接受手术治疗的马蹄足中，残余或复发的马蹄内翻足是一个常见问题。这种畸形可能是由于软组织相关原因引起的，也可能是由于骨畸形引起的。先前在 48%的手术治疗的马蹄足中发现了前远端胫骨角（ADTA）增加。本研究旨在确定在前远端胫骨骺骨切开术（ADTE）治疗患有增加的 ADTA 的复发性马蹄内翻足畸形中的疗效和安全性。

方法

本回顾性单中心研究纳入了 18 名（23 只脚）接受 ADTE 治疗以矫正手术治疗的马蹄足中复发性马蹄内翻足畸形的儿童。ADTE 用于治疗 ADTA 增加（>82 度）且踝关节背屈能力丧失（<0 度背屈）的儿童。患者平均年龄为 11.3 岁（范围：10.2 至 12.9 岁）。所有患者在平均 20.3 个月（范围：9 至 37 个月）后植入物取出后完成治疗。

结果

术前踝关节背屈的平均显着从-3.3 度（范围：-20 至 0 度）改善至 8 板取出时的 6.1 度（范围：-15 至 10 度）（矫正率：9.4 度; P<0.0001）。手术前 ADTA 的平均值为 87.5 度（范围：83 至 110 度），显着改善至植入物取出时的 75.8 度（范围：63 至 106 度）（矫正率：11.7 度; P<0.0001）。平均随访时间为 43.9 个月（范围：10 至 76 个月）。在植入物取出后，继续对 11 名患者（13 只脚）进行随访检查。在该组中，踝关节背屈（平均：-2.5 度）和 ADTA（平均：3.6 度）发生了变化。