Braito Matthias, Radlwimmer Maria, Dammerer Dietmar, Hofer-Picout Philipp, Wansch Jürgen, Biedermann Rainer
Department of Orthopedic Surgery, Medical University of Innsbruck, Austria.
Department of Medical Statistics, Medical University of Innsbruck, Austria.
J Child Orthop. 2020 Jun 1;14(3):221-229. doi: 10.1302/1863-2548.14.190190.
Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology.
We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41).
A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001).
Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot.
IV.
距下关节制动术已被用于治疗柔韧性青少年扁平足。然而，负责畸形矫正的机制尚未得到充分研究。本研究的目的是记录距下关节制动术对跗跖骨形态的影响。
我们回顾性分析了2000年至2018年间在我科接受距下关节制动术治疗的26例（45足）青少年柔韧性扁平足畸形患者的临床和放射学资料。放射学评估包括跗跖骨形态的角度测量以及后足和中足的对线情况。平均影像学随访时间为19.4个月（标准差8.8；12至41个月）。
距下关节制动术后，跗跖骨形态的角度测量有显著变化（p < 0.001）。在前后位片上，远端内侧楔骨角（DMCA）和内侧楔骨-第一跖骨角增加，而在侧位片上，舟骨-内侧楔骨角和内侧楔骨-第一跖骨角减小。此外，我们发现除了外侧胫-跟角和跟骨倾斜角外，所有后足和中足对线参数均有显著改善（p < 0.001）。
我们的数据支持跗跖骨重塑理论，这可能有助于距下关节制动术治疗柔韧性青少年扁平足的效果。
IV级。
