Baylor University Medical Center.
Scottish Rite Hospital for Children, Dallas, TX.
J Pediatr Orthop. 2022;42(5):e453-e458. doi: 10.1097/BPO.0000000000002132.
While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions.
A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Radiographs were analyzed to identify the type of coalition (osseous or nonosseous), presence of any posterior facet involvement, and presence of a planovalgus foot deformity. Patients who underwent a subtalar joint steroid injection after failing other conservative treatments were identified and compared with those who did not receive an injection as part of their nonoperative management with regard to the need for ultimate surgical intervention and the time from presentation to surgery when applicable.
A total of 83 patients (125 feet) met inclusion criteria, of whom 25 patients (34 feet) received a subtalar steroid injection. When compared with the 58 patients (91 feet) treated with standard nonoperative modalities, there were no differences with regard to sex, age at presentation (12.4 and 12.3 y, respectively), facet involvement, type of coalition, or the presence of a planovalgus deformity. In all, 12/34 (35%) feet in the injection group eventually elected surgical intervention compared with 36/91 (39%) feet that did not receive an injection (P=0.72). For those patients ultimately selecting surgical intervention, the average time from initial presentation to surgery was 878 days in the injection group versus 211 days in the noninjection group (P<0.001).
While subtalar steroid injection can alleviate symptoms in some patients with a talocalcaneal coalition, this intervention does not appear to decrease the need for surgery when compared with traditional nonoperative therapies. In patients failing other forms of conservative treatment, subtalar steroid injections can delay surgical intervention by an average of nearly 2 years.
Level-III-therapeutic study.
虽然关节内类固醇注射已被用于治疗对传统保守治疗方法有抵抗的症状性跟距舟骨融合，但这种治疗方法是否能提供症状缓解并避免或延迟手术干预仍不清楚。因此，本研究的目的是评估关节内距下关节类固醇注射治疗症状性跟距舟骨融合的疗效。
对一家儿科骨科机构 30 年来所有孤立性距下关节融合患者进行回顾性研究。对 X 线片进行分析，以确定融合的类型（骨融合或非骨融合）、是否存在任何后关节面受累以及是否存在平足畸形。确定在其他保守治疗失败后接受距下关节类固醇注射的患者，并与未接受注射治疗的患者进行比较，比较内容包括最终是否需要手术干预以及从就诊到手术的时间（适用时）。
共有 83 例患者（125 足）符合纳入标准，其中 25 例（34 足）接受了距下关节类固醇注射。与接受标准非手术治疗的 58 例患者（91 足）相比，两组在性别、就诊时年龄（分别为 12.4 和 12.3 岁）、关节面受累、融合类型或平足畸形方面均无差异。在注射组中，最终选择手术干预的患者有 12/34（35%）足，而未接受注射治疗的患者有 36/91（39%）足（P=0.72）。对于最终选择手术干预的患者，在注射组中，从初次就诊到手术的平均时间为 878 天，而在未注射组中为 211 天（P<0.001）。
虽然距下关节类固醇注射可以缓解一些跟距舟骨融合患者的症状，但与传统非手术治疗相比，这种治疗方法似乎并不能减少手术的需要。对于其他形式的保守治疗失败的患者，距下关节类固醇注射可以平均延迟手术干预近 2 年。
治疗研究，III 级。
