King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Foot Ankle Int. 2021 May;42(5):609-615. doi: 10.1177/1071100720983779. Epub 2021 Feb 9.
Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients' and their caregivers' satisfaction.
We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result.
Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( = .054 and = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( = .025 and = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children's functional status posttalectomy.
The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus.
Level III; retrospective cohort study.
historically ， talectomy 主要用于手术治疗严重僵硬的马蹄内翻足。少数研究人员研究了儿童患者 talectomy 后的功能结果。我们旨在使用美国矫形足踝协会（AOFAS）评分评估接受 talectomy 的儿科患者的结果，并对患者及其照顾者的满意度进行主观调查。
我们在单中心进行了一项回顾性队列研究，使用连续抽样纳入 31 例非特发性严重僵硬的马蹄内翻足患者。回顾了所有患者的病历并提取了相关数据。在最后一次就诊（2020 年 4 月）时使用 AOFAS 评分来测量结果。通过询问患者及其照顾者是否会为相同的结果再次接受相同的手术，以二元方式评估满意度。
纳入 31 例患者。13 例患者（41.9%）的主要诊断为脊髓脊膜膨出，11 例患者（35.5%）诊断为关节挛缩症。22 例患者行双侧手术。手术时的平均年龄为 6.0 ± 3.0 岁，平均随访时间为 6.0 ± 1.0 年。88.5%的病例在初次手术后获得了足底平面。86.5%的患者术后对支具耐受良好。21.2%的患者出现畸形复发，17.3%的患者需要再次手术。关节挛缩症患者的 AOFAS 评分明显高于脊髓脊膜膨出和其他诊断患者（ =.017）。此外，能够耐受支具的患者的 AOFAS 评分高于不能耐受支具的患者（ =.006）。然而，术后出现后足内翻和背侧囊炎的患者 AOFAS 评分较低（ =.054 和 =.006，分别）。出现畸形复发或需要进一步手术的患者 AOFAS 评分也较低（ =.025 和 =.015，分别）。尽管由于一般医疗状况，17.3%的患者无法对其满意度进行评价，但 63.5%的患者表示满意。此外，75.0%的照顾者对手术后的结果和他们孩子的功能状态感到满意。
初次和挽救性 talectomy 的观察结果表明，该手术干预作为儿童严重僵硬马蹄内翻足的终末治疗方法总体上是有效的。
III 级；回顾性队列研究。
