Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; Disaster Medicine Center, Sichuan University, Chengdu, Sichuan Province 610041, China.
Foot Ankle Surg. 2023 Jul;29(5):393-400. doi: 10.1016/j.fas.2023.05.003. Epub 2023 May 16.
Kidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN.
Forty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications.
There were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity.
Kidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch.
III.
Kidner 手术被认为能够消除足底内侧疼痛，并有助于恢复内侧纵弓，因此特别适合治疗合并有症状性 2 型副舟骨（AN）的扁平足。然而，目前仍存在争议，且临床证据仍不足。本研究旨在验证在合并有症状性 2 型 AN 的儿童柔韧性扁平足（PFF）行距下关节融合术（STA）时行 Kidner 手术的必要性。
回顾性分析 40 例（72 足）因柔韧性扁平足行 STA 且同时诊断为症状性 2 型 AN 的患儿的临床资料，根据是否行 Kidner 手术分为两组（STA+Kidner 组与 STA 组）。评估两组患儿的视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）踝-后足评分、儿童牛津足踝问卷（OAFQC）和足部平片参数。主要观察指标为 VAS、AOFAS、OAFQC 评分和足部平片参数。次要观察指标为并发症的发生率。
STA+Kidner 组 35 足，STA 组 37 足，两组的平均随访时间分别为 2.7 年和 2.1 年。两组患儿术前和末次随访时的 VAS、AOFAS、OAFQC 评分和足部平片参数差异均无统计学意义（P>0.05）。两组患儿的 STA 手术并发症发生率差异无统计学意义，Kidner 手术可能会导致更多的切口问题（22.9%比 2.7%）和更长的活动恢复时间。
对于合并有疼痛性 2 型 AN 的 PFF，行 Kidner 手术可能并非必要。单纯矫正 PFF 而保留 AN 有很大可能缓解 AN 区域的疼痛，且将胫骨后肌腱（TPT）转位对重建内侧足弓帮助不大。
III 级。
