Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
Foot (Edinb). 2022 Sep;52:101920. doi: 10.1016/j.foot.2022.101920. Epub 2022 Mar 17.
The aim of this retrospective study is to evaluate the clinical-functional and radiographic results in pediatric patients with painful and disabling Flexible Flat Foot (FFF) refractory to conservative treatment who underwent percutaneous subtalar arthroereisis with a Maxwell Brancheau Arthroereisis® (MBA) implant. Patients aged 8-14 years old with a minimum follow-up of 24 months were included. A pre and postoperative radiographic evaluation was carried out analyzing Meary's angle, internal Moreau-Costa-Bartani´s angle, Talar declination angle, Calcaneal Pitch, Kite's angle, Talar-1st metatarsal angle, and Talonavicular coverage angle. In those patients with more than 5 years of follow-up, the development of subtalar osteoarthritis was evaluated. A clinical-functional evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale. Pre and postoperative pain was evaluated using the visual analog scale (VAS). Postoperative complications were described. Fourteen patients (19 feet) met the inclusion criteria. The mean age at surgery was 12 years old with a mean follow-up of 68.26 months. All radiographic angles improved significantly. No signs of subtalar osteoarthritis were identified. The mean pre and postoperative pain according to VAS was 7.05 and 0.77 respectively. The mean pre and postoperative AOFAS was 75.42 and 97.05 respectively. One female patient had persistent pain in both feet (VAS = 4). However, she was able to do sports and daily life activities without restrictions. None of the implants needed to be removed due to intolerance or pain. Subtalar arthroereisis seems to be effective to improve the clinical-functional and radiographic parameters in moderate pediatric FFF.
本回顾性研究旨在评估对保守治疗无效的疼痛性和致残性可动性平足症（FFF）的儿科患者进行经皮跟骨后关节融合术（subtalar arthroereisis）联合 Maxwell Brancheau 关节融合术（MBA）植入物的临床-功能和影像学结果。纳入年龄 8-14 岁、随访时间至少 24 个月的患者。进行术前和术后影像学评估，分析 Meary 角、内侧 Moreau-Costa-Bartani 角、距骨倾斜角、跟骨倾斜角、Kite 角、距骨第一跖骨角和距舟覆盖角。在随访时间超过 5 年的患者中，评估距下关节炎的发展情况。使用美国矫形足踝协会（AOFAS）踝关节-后足评分量表进行临床-功能评估。使用视觉模拟评分（VAS）评估术前和术后疼痛。描述术后并发症。符合纳入标准的患者有 14 名（19 足）。手术时的平均年龄为 12 岁，平均随访时间为 68.26 个月。所有影像学角度均显著改善。未发现距下关节炎的迹象。根据 VAS 评估，术前和术后的平均疼痛分别为 7.05 和 0.77。术前和术后的 AOFAS 平均分别为 75.42 和 97.05。1 名女性患者双脚持续疼痛（VAS=4）。然而，她能够进行运动和日常生活活动而不受限制。由于不耐受或疼痛，没有植入物需要取出。跟骨后关节融合术似乎可有效改善中度儿科 FFF 的临床-功能和影像学参数。
