跟骨滑动截骨术与跟骨延长截骨术治疗脑瘫儿童足外翻畸形

Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy.

机构信息

Children's Orthopaedic Center, Children's Hospital Los Angeles.

Keck School of Medicine, University of Southern California, Los Angeles, CA.

出版信息

J Pediatr Orthop. 2021 Jul 1;41(6):e433-e438. doi: 10.1097/BPO.0000000000001790.

DOI:10.1097/BPO.0000000000001790

PMID:33734201

Abstract

BACKGROUND

Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population.

METHODS

Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs). Data extraction included complications (modified Clavien-Dindo system), change in standing foot position (modified Yoo system), and change in gait kinematics and kinetics preoperatively to postoperatively. Groups were compared using paired t tests, Fisher exact test, and survivorship analysis using Cox proportional hazard models.

RESULTS

Subjects were 57% male, average age at surgery 11.1 (SD 2.5) years. Average length of follow-up was 3.2 (SD 2.8) years, and was longer in the LCL group (P=0.0004). Complications were minor with similar rates between groups (P=0.14). Prolonged pain and plantar hypersensitivity occurred only in the CS group. Successful maintenance of deformity correction was achieved in 52/73 limbs (71%) in the CS group and 16/44 limbs (36%) in the LCL group (P<0.001). Recurrent pes valgus and need for repeat foot surgery were more common after LCL (P=0.003 and 0.001, respectively). Recurrent pes valgus never occurred when talonavicular fusion was done concomitantly with CS. After accounting for the between group difference in length of follow-up, there was no difference in the rates of recurrent valgus or repeat foot surgery between LCL and CS. None of the variables predicted development of pes varus (P>0.20). Ankle kinematics and kinetics during gait were unchanged in both groups.

CONCLUSIONS

CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

内侧跟骨滑动（CS）截骨术和外侧柱延长术（LCL）常用于缓解脑瘫（CP）和足外翻畸形儿童的疼痛，并改善横断平面对线和步态稳定性。本研究的目的是研究这些手术在该人群中的有效性。

方法

对接受 LCL（26 例，46 肢）或 CS（46 例，73 肢）的 CP 患者进行回顾性病历回顾（包括 3D 步态分析数据）。数据提取包括并发症（改良 Clavien-Dindo 系统）、站立足位变化（改良 Yoo 系统）以及术前至术后步态运动学和动力学的变化。使用配对 t 检验、Fisher 确切检验和 Cox 比例风险模型进行生存分析比较组间差异。

结果

受试者中男性占 57%，手术时的平均年龄为 11.1（SD 2.5）岁。平均随访时间为 3.2（SD 2.8）年，LCL 组更长（P=0.0004）。并发症轻微，两组之间发生率相似（P=0.14）。CS 组仅出现慢性疼痛和足底感觉过敏。CS 组中，73 肢中有 52 肢（71%）成功维持畸形矫正，LCL 组中，44 肢中有 16 肢（36%）成功维持畸形矫正（P<0.001）。LCL 后更常见复发足外翻和需要重复足部手术（P=0.003 和 0.001）。当 CS 同时进行距下关节融合时，不会发生复发性足内翻。考虑到随访时间的组间差异，LCL 和 CS 之间的复发性外翻或重复足部手术率无差异。在两种手术中，变量均未预测足内翻的发生（P>0.20）。步态中踝关节的运动学和动力学在两组中均未改变。