精心设计的经皮跟腱切断术在先天性马蹄内翻足功能治疗中的应用：哪些适应证能产生最佳结果？

Well though-out introduction of percutaneous Achilles tenotomy during functional treatment of congenital talipes equinovarus: Which indications produce the best results?

机构信息

Hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvre, 75015 Paris, France.

出版信息

Orthop Traumatol Surg Res. 2023 May;109(3):102932. doi: 10.1016/j.otsr.2021.102932. Epub 2021 Apr 20.

DOI:10.1016/j.otsr.2021.102932

PMID:33857683

Abstract

INTRODUCTION

Percutaneous Achilles tenotomy (PAT) was recently added to functional treatment of congenital talipes equinovarus (aka clubfoot). The aim of this study was to determine the relevance of a carefully chosen radiological criterion for the PAT indication and to evaluate its results.

HYPOTHESIS

When the tibiocalcaneal angle (aTiCa) is larger than 75° at 4 months, doing PAT will improve the results of the functional method in the medium term and will reduce the surgery rate.

PATIENTS AND METHODS

This prospective study involved 101 patients (151 feet) born between 2011 and 2014 with clubfoot who were treated with the French functional method and had at least 4 years' follow-up. The initial severity of the deformity was evaluated using the Diméglio scoring system. In our sample, 30 feet had a Diméglio rating of II (20%), 61 had a Diméglio rating of III (40%) and 60 feet had a Diméglio rating of IV (40%). The indication for PAT was made at 4 months of age when the aTiCa on a lateral radiograph of the foot in maximum correction was greater than 75°. The mean follow-up was 5 years. The final assessment was done using the modified Ghanem and Seringe classification.

RESULTS

In the entire cohort, PAT was done in 113 feet (75%). None of the feet required a repeat PAT. Surgical release of the soft tissues was done in 20 feet (13%). None of the feet developed a rocker bottom deformity. Two feet were operated in the absence PAT (out of 38 in this subgroup) and 18 feet after PAT (out of 113 in this subgroup). The aTiCa angle did not vary in the PAT group based on whether surgical release was indicated afterwards or not. At the final assessment, 140 feet (93%) were classified as very good and 11 feet (7%) as good.

DISCUSSION

The tibiocalcaneal angle is a relevant radiological criterion for the PAT indication in children with clubfoot. PAT has a positive impact on the outcomes.

LEVEL OF EVIDENCE

II; prospective study.

摘要

简介

经皮跟腱切断术（PAT）最近被加入到先天性马蹄内翻足（也称为马蹄足）的功能治疗中。本研究的目的是确定一个精心选择的影像学标准对 PAT 适应证的相关性，并评估其结果。

假说

如果在 4 个月时，距跟骨角（aTiCa）大于 75°，则进行 PAT 将在中期改善功能治疗方法的结果，并降低手术率。

患者和方法

这是一项前瞻性研究，纳入了 2011 年至 2014 年间出生的 101 例（151 足）患有马蹄足的患者，他们采用法国功能治疗方法，并且至少随访了 4 年。畸形的初始严重程度采用迪梅利奥评分系统进行评估。在我们的样本中，30 足的迪梅利奥评分为 II 级（20%），61 足的迪梅利奥评分为 III 级（40%），60 足的迪梅利奥评分为 IV 级（40%）。当足部在最大矫正时的侧位 X 光片上的 aTiCa 大于 75°时，在 4 个月大时进行 PAT 的适应证。平均随访时间为 5 年。最终评估采用改良的加纳姆和塞林格分类法进行。

结果

在整个队列中，113 足（75%）进行了 PAT。无一足需要再次 PAT。20 足（13%）行软组织松解术。无一足出现摇椅底畸形。2 足在无 PAT 情况下（该亚组 38 足中）进行了手术，18 足在 PAT 后（该亚组 113 足中）进行了手术。在 PAT 组中，根据是否需要随后进行手术松解，aTiCa 角度没有变化。在最终评估时，140 足（93%）被评为非常好，11 足（7%）为好。