Neuro-Orthopaedic Unit.
Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Princesa, Madrid, Spain.
J Pediatr Orthop. 2022 Apr 1;42(4):e377-e383. doi: 10.1097/BPO.0000000000002081.
Planovalgus foot (PVF) in cerebral palsy (CP) tends toward progression and rigidity in adolescence, especially in patients with greater functional impairment. Deformity at the talonavicular joint justifies the use of talonavicular arthrodesis as a corrective surgical technique. This study aims to assess patient or caregiver functional satisfaction and radiographic outcomes of talonavicular arthrodesis for PVF in CP patients with assisted ambulation in the long-term.
Retrospective comparative study of level III and level IV pediatric CP patients who underwent talonavicular arthrodesis for PVF between 1999 and 2010 as part of multilevel surgery and with a minimum follow-up of 10 years. Radiologic correction at 10 years was compared with preintervention values, and functional impact at 10 years was measured by the foot function index (FFI); correlation between radiologic measurements and FFI were obtained, and complications were recorded.
Forty-nine PVFs in 25 patients with CP (72% level III and 28% level IV) were included; 52% were male. The patients had a median age of 12 years at the time of surgery (range: 11 to 15) and 23 years at the time of the study (21 to 26). Significant (P<0.01) pre-post radiologic improvements were obtained in Meary angle (37.86±10.7/8.37±5.5 degrees), calcaneal pitch (3.20±8.1/13.22±5.6 degrees), lateral talocalcaneus angle (42.18±12.1/25.29±2.9 degrees), Moreau-Costa-Bartani angle (167.04±8/146.12±7.1 degrees), talus-first metatarsal angle (27.92±13.9/9.69±4.4 degrees), anteroposterior talocalcaneal angle (37.61±7.4/22.61±2.4 degrees), and talus coverage angle (37.04±11.11/2.45±2.5 degrees). At 10 years postoperatively, functional outcome measured with the FFI was satisfactory (33.9±15.2%) and the mean maximum pain was 3.04; 56% of cases had mild pain. All patients were able to wear an ankle-foot orthosis and 8 no longer needed the device. A significant correlation was found between the talofirst metatarsal angle and the FFI (P=0.024). There were 8% of cases with screw protrusion and 14% presented pseudarthrosis, most of them asymptomatic.
The adequate functional outcome, as well as the persistence of long-term radiologic correction and acceptable number of complications, enables us to recommend talonavicular arthrodesis as an alternative treatment to consider in level III and level IV CP patients with PVF.
Level III-retrospective comparative study.
脑瘫（CP）患者的足内翻（PVF）在青春期往往会进展并变得僵硬，尤其是在功能障碍较大的患者中。距跟关节的畸形证明距跟关节融合术作为一种矫正手术技术是合理的。本研究旨在评估 CP 患者在辅助行走的情况下，接受距跟关节融合术治疗 PVF 后，长期（10 年以上）的患者或照顾者的功能满意度和影像学结果。
回顾性比较了 1999 年至 2010 年期间接受距跟关节融合术治疗 PVF 的 III 级和 IV 级小儿 CP 患者，作为多水平手术的一部分，且随访时间至少为 10 年。将 10 年时的影像学矫正与术前值进行比较，并通过足部功能指数（FFI）测量 10 年时的功能影响；获得影像学测量值与 FFI 的相关性，并记录并发症。
25 例 CP 患者的 49 个 PVF（72%为 III 级，28%为 IV 级）被纳入研究；52%为男性。患者手术时的中位年龄为 12 岁（范围：11 至 15 岁），研究时的中位年龄为 23 岁（范围：21 至 26 岁）。Meary 角（37.86±10.7/8.37±5.5 度）、跟骨倾斜角（3.20±8.1/13.22±5.6 度）、外侧距跟骨角（42.18±12.1/25.29±2.9 度）、Moreau-Costa-Bartani 角（167.04±8/146.12±7.1 度）、距骨第一跖骨角（27.92±13.9/9.69±4.4 度）、前后距跟骨角（37.61±7.4/22.61±2.4 度）和距骨覆盖角（37.04±11.11/2.45±2.5 度）在术后 10 年时均有显著（P<0.01）的影像学改善。术后 10 年，FFI 测量的功能结果满意（33.9±15.2%），平均最大疼痛为 3.04；56%的病例有轻度疼痛。所有患者均能穿踝足矫形器，8 例不再需要该装置。距骨第一跖骨角与 FFI 之间存在显著相关性（P=0.024）。有 8%的病例出现螺钉突出，14%出现假关节，大多数无症状。
适当的功能结果，以及长期影像学矫正的维持和可接受的并发症数量，使我们能够推荐距跟关节融合术作为 CP 患者伴 PVF 的 III 级和 IV 级的替代治疗方法。
III 级-回顾性比较研究。
