Hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
Hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Centre Hospitalier Inter-Communal Robert Ballanger, boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France.
Orthop Traumatol Surg Res. 2023 May;109(3):103146. doi: 10.1016/j.otsr.2021.103146. Epub 2021 Nov 12.
The aim of the present study was to define indications for talectomy in congenital paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot.
Talectomy is a valid option for paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot.
A single-center retrospective series comprised 52 clubfeet in 31 patients. Etiology was paralytic in 34 feet (65%) (17 arthrogryposes, 10 myelomeningoceles, 4 encephalopathies, 3 peripheral neuropathies), dystrophic in 6 (12%) and idiopathic in 12 (23%). In 27 feet, there was history of surgery (52%). Mean age at talectomy was 4.7 years. In 45 feet (87%), there were associated procedures (soft-tissue release, tendon surgery, calcaneal or lateral arch osteotomy, tibiocalcaneal fusion) and talectomy was isolated in 7 feet (13%). Mean follow-up was 9 years. Final assessment was based on the modified Ghanem and Seringe classification (G&S) and the Ankle-Hindfoot Scale (AHS).
All feet required at least one complementary procedure, either in the same step or as revision. Revision surgery was performed in 17 cases (33%), including all 7 feet with isolated talectomy (7 calcaneal tendon lengthenings, 10 mid- or hind-foot osteotomies, 6 tibiocalcaneal fusions, one calcaneocuboid fusion, and 2 progressive corrections by external fixator). Finally, 33 feet (63%) had good G&S results, 44 (85%) were pain-free, and 40 (77%) were plantigrade.
Talectomy for paralytic or dystrophic inveterate or recurrent clubfoot provided satisfactory medium-term results. Associated to other procedures, it achieves a pain-free plantigrade foot in most cases. Tibiocalcaneal fusion has an analgesic effect. Talectomy may, however, not be indicated in idiopathic clubfoot, given the patients' high functional demand and the existence of alternative treatments.
IV, retrospective series.
本研究旨在为先天性麻痹性、营养不良性或特发性、陈旧性或复发性马蹄足确定跟骨切除术的适应证。
跟骨切除术是治疗麻痹性、营养不良性或特发性、陈旧性或复发性马蹄足的有效选择。
一项单中心回顾性系列研究纳入了 31 名患者的 52 例马蹄足。病因学方面，34 例（65%）为麻痹性（17 例关节挛缩，10 例脊髓脊膜膨出，4 例脑病，3 例周围神经病），6 例（12%）为营养不良性，12 例（23%）为特发性。27 例（52%）有手术史。跟骨切除术的平均年龄为 4.7 岁。45 例（87%）有联合手术（软组织松解、肌腱手术、跟骨或外侧弓截骨、距跟骨融合），7 例（13%）仅行跟骨切除术。平均随访时间为 9 年。最终评估基于改良的 Ghanem 和 Seringe 分类（G&S）和踝关节后足评分（AHS）。
所有足部均至少需要一种补充手术，无论是在同一步骤还是作为翻修手术。17 例（33%）进行了翻修手术，包括 7 例单纯跟骨切除术（7 例跟腱延长术、10 例中后足截骨术、6 例距跟骨融合术、1 例跟骰骨融合术和 2 例外固定器逐步矫正术）。最终，33 例（63%）足部 G&S 结果良好，44 例（85%）足部无疼痛，40 例（77%）足部能负重行走。
对于陈旧性或复发性麻痹性或营养不良性马蹄足，跟骨切除术可获得满意的中期疗效。与其他手术联合应用，可使大多数病例获得无痛、负重良好的足部。距跟骨融合术具有镇痛作用。然而，对于特发性马蹄足，跟骨切除术可能不适用，因为患者对功能的要求较高，而且存在其他治疗方法。
IV，回顾性系列研究。
