Stevens Peter, Lancaster Alex, Khwaja Ansab
Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America.
Department of Orthopedics, University of Arizona, Phoenix, Arizona, United States of America.
Strategies Trauma Limb Reconstr. 2021 Sep-Dec;16(3):168-171. doi: 10.5005/jp-journals-10080-1538.
While surgical stabilisation of the subtalar joint (arthroeresis) in children remains controversial in the USA, it is widely practised worldwide, with reportedly good outcomes. We are presenting a series of patients who met our criteria for calcaneal lengthening, but whose parents chose the less invasive option of talo-tarsal stabilisation (TTS). The goal of this surgery was to forestall or prevent hindfoot osteotomy.
With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6-15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2).
In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary.
TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus.
IV retrospective case series.
Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168-171.
在美国，儿童距下关节手术稳定术（关节制动术）仍存在争议，但在全球范围内广泛应用，据报道效果良好。我们报告了一系列符合我们跟骨延长标准的患者，但他们的父母选择了侵入性较小的距骨 - 跗骨稳定术（TTS）。该手术的目的是预防或避免后足截骨术。
经机构审查委员会（IRB）批准，我们对32例患者（60足）进行了回顾性研究，这些患者因柔韧性扁平外翻畸形接受了TTS手术，且至少随访1年。大多数患者病因不明，少数为神经源性或综合征性。年龄范围为6至15岁；较年轻的患者有神经肌肉病因或潜在综合征。同期手术包括经皮跟腱延长术（33足）、Kidner手术（9足）和踝关节外翻的引导性生长术（2例）。
在固定后的早期阶段，4例患者（6足）出现腓骨痉挛。3例患者通过注射肉毒杆菌毒素到短腓骨肌得以缓解，1例患者需要将短腓骨肌转移至长腓骨肌。随访时间为1至4.5年，50枚植入物（83.4%）得以保留，患者报告结果满意。此后，这些患者将按需进行监测。由于持续不适，1例患者重新定位了植入物，5例患者（10足 = 16.6%）取出了植入物。进一步随访发现，这些患者未出现复发性畸形。因此，无需通过截骨术和/或跟骨延长术进行后续挽救治疗。
对于有症状的扁平足，TTS联合其他必要手术，比目前更常用的内侧移位截骨术或跟骨延长术具有优势。1年时的结果可很好地预测是否需要进一步治疗。与其他手术治疗方法相比，这是一种更简单且更可取的选择，根据我们的经验，它避免了跟骨截骨术或延长术的需要。
IV级回顾性病例系列。
Stevens P, Lancaster A, Khwaja A. Talar - tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168 - 171.
