Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
Orthopedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Int Orthop. 2024 Jun;48(6):1543-1552. doi: 10.1007/s00264-023-06011-5. Epub 2023 Oct 20.
We aimed to report early results of performing joint-preserving surgeries for managing spasmodic flatfoot deformity (SFFD) in adolescents.
A prospective case series study including 24 patients (27 feet) diagnosed with idiopathic SFFD not responding to conservative management. After reassessment under anesthesia, surgical procedures included soft tissue releases (Achilles tendon (AT), peroneus brevis (PB), peroneus tertius (PT) (if present), and extensor digitorum longus (EDL)), bony osteotomies (lateral column lengthening (LCL), medial displacement calcaneal osteotomy (MDCO), and double calcaneal osteotomy (DCO)), and medial soft tissue reconstruction or augmentation if needed. Functional evaluation was performed per the American Orthopedic Foot and Ankle Society (AOFAS) score, while radiological parameters included talo-navicular coverage angle (TNCA), talo-first metatarsal angle (AP Meary's angle), calcaneal inclination angle (CIA), talo-calcaneal angle (TCA), talo-first metatarsal angle (Lat. Meary's angle), and tibio-calcaneal angle (TibCA). The preoperative parameters were compared to the last follow-up using the Wilcoxon signed test.
The mean age was 15.37 ± 3.4 years, 18 (75%) were boys, and the mean BMI was 28.52 ± 3.5 (kg/m). Release of AT and fractional lengthening of PL, PT, and EDL were performed in all patients. LCL was needed in eight feet (29.6%), MDCO in 5 (18.5%), and DCO in 14 (51.9%). FDL transfer was required in 12 (44.4%) feet, and repair of the spring ligament in seven (25.9%). The mean operative time was 99.09 ± 15.67 min. All osteotomies were united after a mean of 2.3 ± 0.5 months. After a mean follow-up of 24.12 ± 8.88 months (12 and 36 months), the AOFAS improved from a preoperative mean of 43.89 ± 11.49 to a mean of 87.26 ± 9.92 (P < 0.001). All radiological parameters showed significant improvement, AP Meary's angle from a mean of 20.4 ± 5.3 to a mean of 9.2 ± 2.1, Lat. Meary's angle from - 15.67° ± 6.31 to - 5.63° ± 5.03, TNCA from - 26.48° ± 5.94 to 13.63° ± 4.36, CIA from 12.04° ± 2.63 to 16.11° ± 3.71, TibCA from - 14.04° ± 3.15 to - 9.37° ± 3.34, and TCA Lat. from 42.65° ± 10.68 to 25.60° ± 5.69 (P ≤ 0.001). One developed wound dehiscence (over an MDCO), managed with daily dressings and local antibiotics. Another one developed lateral foot pain after having LCL managed by metal removal.
Careful clinical and radiological evaluation for the correct diagnosis of SFFD is paramount. Joint-preserving bony osteotomies combined with selective soft tissue procedures resulted in acceptable functional and radiological outcomes in this young age group.
报告为管理青少年痉挛性平足畸形（SFFD）而进行保关节手术的早期结果。
前瞻性病例系列研究包括 24 名（27 只脚）诊断为特发性 SFFD 且对保守治疗无反应的患者。在麻醉下重新评估后，手术包括软组织松解（跟腱（AT）、短腓骨（PB）、第三腓骨（PT）（如有）和伸趾长肌（EDL））、骨截骨术（外侧柱延长术（LCL）、内侧移位跟骨截骨术（MDCO）和双跟骨截骨术（DCO））以及如果需要，内侧软组织重建或增强。功能评估采用美国骨科足踝协会（AOFAS）评分，而放射学参数包括距下关节覆盖率角（TNCA）、距第一跖骨角（AP Meary 角）、跟骨倾斜角（CIA）、跟距角（TCA）、距第一跖骨角（Lat. Meary 角）和胫距角（TibCA）。使用 Wilcoxon 符号秩检验将术前参数与最后随访进行比较。
平均年龄为 15.37±3.4 岁，18 名（75%）为男性，平均 BMI 为 28.52±3.5（kg/m）。所有患者均行 AT 松解和短腓骨、PT 和 EDL 的部分延长。8 只脚（29.6%）需要 LCL，5 只脚（18.5%）需要 MDCO，14 只脚（51.9%）需要 DCO。12 只脚（44.4%）需要 FDL 转移，7 只脚（25.9%）需要修复弹簧韧带。平均手术时间为 99.09±15.67 分钟。所有截骨均在平均 2.3±0.5 个月后愈合。平均随访 24.12±8.88 个月（12 个月和 36 个月）后，AOFAS 从术前的 43.89±11.49 提高到 87.26±9.92（P<0.001）。所有放射学参数均显示出显著改善，AP Meary 角从平均 20.4±5.3 提高到平均 9.2±2.1，Lat. Meary 角从-15.67°±6.31 提高到-5.63°±5.03，TNCA 从-26.48°±5.94 提高到 13.63°±4.36，CIA 从 12.04°±2.63 提高到 16.11°±3.71，TibCA 从-14.04°±3.15 提高到-9.37°±3.34，和 TCA Lat. 从 42.65°±10.68 提高到 25.60°±5.69（P≤0.001）。1 例出现 MDCO 切口裂开，经每日换药和局部抗生素治疗后愈合。另 1 例 LCL 后出现外侧足部疼痛，经去除金属后缓解。
对 SFFD 的正确诊断需要进行仔细的临床和放射学评估。在这个年轻的年龄组中，保关节的骨截骨术结合选择性软组织手术可获得可接受的功能和放射学结果。
