Department of Oncology and Metabolism, The Sheffield University Medical School, United Lincolnshire Hospitals Trust.
Paediatric Orthopaedic Royal Manchester Children Hospital, Manchester, UK.
J Pediatr Orthop. 2021 Apr 1;41(4):249-254. doi: 10.1097/BPO.0000000000001769.
Congenital vertical talus (CVT) is a rare congenital foot disorder. Approximately half of the affected children have associated neuromuscular syndromes which may further complicate the treatment. The traditional treatment involved extensive soft tissue and bony reconstructions. The minimally invasive method (Dobbs method/reverse Ponseti) has changed the treatment of CVT. There is significant variation of the reported outcome of this method in the current literature. In this study we report the outcome of this minimally invasive technique for treatment of CVT and compare the results of treatment in syndromic and idiopathic patients.
Idiopathic and syndromic patients treated from CVT with minimally invasive method from 2006 till 2016 were included in this retrospective study. We reviewed the patients' notes, radiographs and collected parents reported outcome questionnaire (Roye score) in addition to clinical examination to comprehensively report the treatment outcome.
A total of 21 patients 30 feet were included in this study. The average age of commencing treatment was 6 months (1 to 17 mo). The mean follow-up was 6.5 years (1 to 11 y). Correction of the deformities and abnormal angles were achieved in all feet. Five of the 17 syndromic feet had recurrence while no recurrence was reported in any if the 13 idiopathic feet. At the time of the index procedure no supplementary procedures were required. The average arc of motion for foot ankle dorsiflexion and plantar flexion was 30 degrees. Patients with idiopathic CVT had a mean the Roye score of 11 while syndromic patients had a mean score of 22.
The minimally invasive method is a valuable option for treatment of CVT. Idiopathic patients had no recurrence and better functional scores compared syndromic patients. There was no requirement for supplementary procedures such as tibialis anterior transfer or anterolateral release at the time of the initial surgery.
Level IV-case series.
先天性垂直距骨（CVT）是一种罕见的先天性足畸形。大约一半的患儿伴有神经肌肉综合征，这可能使治疗更加复杂。传统的治疗方法包括广泛的软组织和骨骼重建。微创方法（Dobbs 法/反向 Ponseti 法）改变了 CVT 的治疗方法。目前文献中报道的这种方法的结果存在很大差异。在本研究中，我们报告了这种微创技术治疗 CVT 的结果，并比较了综合征和特发性患者的治疗结果。
本回顾性研究纳入了 2006 年至 2016 年期间采用微创方法治疗 CVT 的特发性和综合征患者。我们查阅了患者的病历、影像学资料，并收集了家长报告的结果问卷（Roye 评分）以及临床检查，以全面报告治疗结果。
本研究共纳入 21 例 30 足患者。开始治疗的平均年龄为 6 个月（1 至 17 个月）。平均随访时间为 6.5 年（1 至 11 年）。所有足部的畸形和异常角度均得到矫正。17 例综合征足中有 5 例出现复发，而 13 例特发性足中无一例复发。在初始手术时，无需进行其他补充手术。足踝关节背屈和跖屈的平均活动弧为 30 度。特发性 CVT 患者的 Roye 评分为 11 分，而综合征患者的评分为 22 分。
微创方法是治疗 CVT 的一种有价值的选择。特发性患者无复发且功能评分优于综合征患者。在初始手术时，无需进行其他补充手术，如胫骨前肌转移或前外侧松解术。
IV 级-病例系列研究。
