Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, MO.
J Pediatr Orthop. 2022 Oct 1;42(9):503-508. doi: 10.1097/BPO.0000000000002235. Epub 2022 Aug 11.
Historically, treatment for congenital vertical talus (CVT) has included open reduction of the talonavicular joint and extensive soft tissue release. In 2006, a new minimally invasive method consisting of serial manipulation and casting followed by percutaneous fixation of the talonavicular joint and percutaneous Achilles tenotomy was introduced. Although the early results of this new technique are promising, more research is needed to verify that the talonavicular correction is maintained with time.
We conducted a retrospective chart review of all patients with idiopathic CVT who underwent minimally invasive correction by a single surgeon at a tertiary care institution. Radiographic evaluation of the preoperative, immediate postoperative, 1 year postoperative and latest follow-up appointments were performed. Complications and clinical outcomes were recorded. Radiographic recurrence of the deformity was defined as lateral talar axis-first metatarsal base angle >30 degrees. Statistical analysis was performed on the maintenance of radiographic correction and factors associated with recurrence.
Forty seven feet in 35 patients were included in the study with average follow-up of 45 months. The average preoperative lateral talar axis-first metatarsal base angle was 74±18 compared with 12±8 after initial surgical intervention. In addition, radiographic correction of all other measured angles was achieved in every child following the initial surgery. Radiographic recurrence of talonavicular deformity was seen in 4 feet (9%). No cases of recurrence required a second corrective surgery during the follow-up period. There was a significant association between patient age at the time of treatment and recurrence of talonavicular deformity with patients older than 12 months being more likely to experience recurrence ( P =0.041).
In this large series, we found that correction of talonavicular deformity can be achieved and maintained in a large majority of children with idiopathic CVT who undergo treatment with this minimally invasive technique and recurrences are uncommon. Treatment with this technique should be initiated as soon as a diagnosis of CVT is confirmed and the patient is medically stable to decrease the likelihood of experiencing recurrence of talonavicular deformity.
Level III.
先天性垂直距骨（CVT）的传统治疗方法包括距跟关节切开复位以及广泛的软组织松解。2006 年，一种新的微创方法被引入，该方法包括连续手法复位和石膏固定，然后进行距跟关节经皮固定和经皮跟腱切断术。尽管该新技术的早期结果很有前景，但仍需要更多的研究来验证距跟矫正是否能随时间而保持。
我们对在一家三级医疗机构接受单一外科医生微创矫正的所有特发性 CVT 患者进行了回顾性图表审查。对术前、术后即刻、术后 1 年和最新随访的 X 线片进行评估。记录并发症和临床结果。将畸形的放射学复发定义为外侧距骨轴-第一跖骨基底角>30 度。对放射学矫正的维持情况以及与复发相关的因素进行了统计学分析。
研究纳入 35 例患者的 47 只脚，平均随访 45 个月。平均术前外侧距骨轴-第一跖骨基底角为 74°±18°，与初次手术干预后的 12°±8°相比。此外，所有患儿在初次手术后，所有其他测量角度的放射学矫正均得到了改善。4 只脚（9%）出现距跟骨畸形的放射学复发。在随访期间，没有病例需要再次进行矫正手术。治疗时患者的年龄与距跟骨畸形的复发有显著相关性，12 个月以上的患者更有可能出现复发（P=0.041）。
在这项大型研究中，我们发现，采用这种微创技术治疗特发性 CVT 的大多数儿童可以实现并维持距跟骨畸形的矫正，且复发并不常见。一旦确诊 CVT 并在患儿身体状况稳定的情况下进行治疗，应尽早开始使用该技术，以降低距跟骨畸形复发的可能性。
III 级。
