Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
Department of Orthopedics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
J Neuromuscul Dis. 2022;9(5):641-648. doi: 10.3233/JND-220803.
Progressive equinovarus deformities are common in people with Duchenne Muscular Dystrophy (DMD); they may provoke pain, pressure spots, cause problems with wearing footwear, and may lead to an unstable sitting position.
Explore indications and compare complications and long-term outcomes after soft tissue and osseous interventions in people with DMD.
Retrospective, monocenter, longitudinal study. Data on indications, equinus and varus deformity before and after surgery, wound healing problems, 'pain', edema, and long-term outcomes were collected from medical files. Soft tissue interventions were compared with osseous interventions.
From a series of 18 patients, data on 32 surgical interventions and 169 follow-up visits were analyzed. 'Footrest placement' was the most frequent surgical indication, followed by pain. Osseous interventions were performed in older patients with rigid deformities. Directly after surgery remaining deformities were reported after soft tissue interventions (18 %), no remaining deformities were reported after osseous interventions. Pain and edema were frequently present, especially after osseous surgery. Longitudinal follow-up showed that surgical interventions could lead to a neutral foot for a for more than 3 years on average years. Relapses of foot deformity occurred, especially the recurrence of varus deformity after osseous interventions.
Surgical interventions can successfully lead to a neutral foot position for for more than 3 years on average. Soft tissue interventions appear to be superior to osseous corrections, considering the varus recurrence period and complications, and may be considered when feet are still (partly) correctable. Pain management and edema prevention should be anticipated before surgery. Future research on patient reported outcomes as well as evaluating the outcome of the initial indication is needed to further identify benefits.
进行性马蹄内翻足畸形在杜氏肌营养不良症（DMD）患者中很常见；它们可能会引起疼痛、压疮，导致穿鞋困难，并可能导致坐姿不稳定。
探讨杜氏肌营养不良症患者软组织和骨干预的适应证，并比较其并发症和长期疗效。
回顾性、单中心、纵向研究。从病历中收集适应证、手术前后马蹄内翻畸形、伤口愈合问题、“疼痛”、水肿以及长期疗效的数据。比较软组织干预与骨干预。
对 18 例患者的 32 次手术干预和 169 次随访进行了分析。“放置足托”是最常见的手术指征，其次是疼痛。骨干预用于年龄较大、畸形僵硬的患者。软组织干预后直接报告残留畸形（18%），骨干预后无残留畸形。疼痛和水肿很常见，尤其是在骨手术后。纵向随访显示，手术干预平均可使足部保持中立位置超过 3 年。足部畸形会复发，尤其是骨干预后出现内翻畸形复发。
手术干预可使足部平均保持中立位置超过 3 年。考虑到内翻畸形的复发期和并发症，软组织干预似乎优于骨矫正，当足部仍可（部分）矫正时，可以考虑软组织干预。手术前应预测疼痛管理和水肿预防。需要进一步确定益处的未来研究是评估患者报告的结局和初始适应证的结果。
