Li Bing, He Wenbao, Yu Guangrong, Zhou Haichao, Xia Jiang, Zhao Youguang, Zhu Hui, Yu Tao, Yang Yunfeng
Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Front Pediatr. 2021 May 21;9:656178. doi: 10.3389/fped.2021.656178. eCollection 2021.
Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment. And for some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory. The main aim of the present study was to investigate the therapeutic outcomes of subtalar arthroereisis combined with Achilles tendon or gastrocnemius recession and medial soft tissue (spring ligament, talonavicular joint capsule, tibionavicular ligaments and tibiospring ligaments) tightening for treating flexible flatfoot with severe deformities. Thirty patients (32 feet) with pediatric flexible flatfoot who underwent subtalar arthroereisis and soft tissue procedures during January 2016 to January 2018. There were 18 males (20 feet) and 12 females (12 feet) with an average age of 9.5 years (range, 8-12 years). We used the AOFAS scores and VAS scores combined with angles measure to evaluate the pre-operative and post-operative status. Thirty patients (32 feet) were followed up for 25.3 months on average (range, 18-36 months). There was no infection. Post-operative foot pain, arch collapse, and other symptoms improved. At last follow-up, the Meary angle was decreased from 17.5° ± 4.4° to 4.1° ± 1.2° ( < 0.05), the talar-first metatarsal (AP) was decreased from 15.3° ± 3.1° to 4.8° ± 1.3°( < 0.05), The mean AOFAS score was rose from 66.6 ± 5.8 to 88.6 ± 7.9 ( < 0.05), the mean VAS score was decreased from 6.6 ± 0.6 to 1.7 ± 0.3 ( < 0.05). The subtalar arthroereisis combined with soft tissue procedures can effectively correct flexible flatfoot in children and it is a significant method for severe forefoot abduction reconstruction. IV.
柔韧性扁平足在临床上较为常见，关于手术治疗尚无统一结论。对于一些畸形严重的患者，距下关节制动联合跟腱松解或腓肠肌松解的矫正效果仍不尽人意。本研究的主要目的是探讨距下关节制动联合跟腱或腓肠肌延长及内侧软组织（弹簧韧带、距舟关节囊、胫舟韧带和胫弹簧韧带）紧缩治疗重度畸形柔韧性扁平足的疗效。2016年1月至2018年1月期间，30例（32足）患有小儿柔韧性扁平足的患者接受了距下关节制动和软组织手术。其中男性18例（20足），女性12例（12足），平均年龄9.5岁（范围8 - 12岁）。我们采用美国足踝外科协会（AOFAS）评分、视觉模拟评分（VAS）结合角度测量来评估术前和术后情况。30例（32足）患者平均随访25.3个月（范围18 - 36个月）。无感染发生。术后足部疼痛、足弓塌陷等症状改善。末次随访时，Meary角从17.5°±4.4°降至4.1°±1.2°（P<0.05），距骨 - 第一跖骨（前后位）角从15.3°±3.1°降至4.8°±1.3°（P<0.05），平均AOFAS评分从66.6±5.8升至88.6±7.9（P<0.05），平均VAS评分从6.6±0.6降至1.7±0.3（P<0.05）。距下关节制动联合软组织手术能有效矫正儿童柔韧性扁平足，是重度前足外展重建的重要方法。 四、
