Stamatos Nicholas J, Murasko Marlon J, Richardson Kyle, O'Connor Casey, Anoushiravani Afshin A, Adams Curtis, Rosenbaum Andrew
Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA.
Foot Ankle Orthop. 2023 Jun 4;8(2):24730114231176554. doi: 10.1177/24730114231176554. eCollection 2023 Apr.
Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD.
We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar-first metatarsal angle (T-1MT), and calcaneal pitch.
A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year.
At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL.
Level III, retrospective cohort study.
外侧柱延长术（LCL）是一种用于治疗前足外展的外科手术，理论上，对于IIB期成人获得性平足畸形（AAFD）患者，通过拉紧腓骨长肌使第一跖骨跖屈，该手术还能增加纵弓高度。此手术采用跟骨开口楔形截骨术，然后用自体骨移植、异体骨移植或多孔金属楔填充。本研究的主要目的是比较IIB期AAFD患者行LCL术后使用这些不同骨替代物的影像学结果。
我们对2008年10月至2018年10月期间所有接受LCL手术的患者进行了回顾性研究。回顾了术前负重X线片、术后初期X线片和术后1年负重X线片。记录了以下影像学测量数据：不匹配角、距舟覆盖角（TNCA）、距骨-第一跖骨角（T-1MT）和跟骨倾斜度。
我们的研究共纳入44例患者。该队列的平均年龄为54岁（范围18 - 74岁）。研究队列分为2组。17例（38.7%）患者接受了钛金属楔，27例（61.5%）接受了自体骨移植或异体骨移植。接受自体骨移植/异体骨移植组行LCL手术的患者年龄显著更大（59岁对47岁，P = 0.006）。接受钛楔行LCL手术的患者术前距舟角显著更高（32度对27度，P = 0.013）。术后6个月或1年时，TNCA、不匹配角或跟骨倾斜度无显著差异。
在术后6个月和1年时，LCL手术中自体骨移植/异体骨移植骨替代物与钛楔之间未发现影像学差异。
III级，回顾性队列研究。
