Corradin Marco, Schiavon Roberto, Micaglio Andrea, Pierantoni Silvia, Luppi Valentina, Canavese Federico
Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy.
Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy.
Eur J Orthop Surg Traumatol. 2024 May;34(4):2163-2170. doi: 10.1007/s00590-024-03914-w. Epub 2024 Apr 3.
Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA).
A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01.
Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing.
SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications.
IV.
扁平外翻足畸形（PVFD）在患有神经肌肉疾病的儿童中很常见，严重畸形可能需要手术矫正。本研究旨在评估距下关节制动术（SuAE）、中足软组织松解术和距舟关节融合术（TNA）治疗继发于神经肌肉疾病的PVFD的临床和影像学结果。
对接受SuAE、中足软组织松解术和TNA且至少随访5年的患有神经肌肉疾病和不可复位PVFD的儿童进行回顾性分析。共纳入60例包括脑瘫在内的神经肌肉疾病患者（108只脚）。手术时的平均年龄为12.7±4.6岁（6 - 17岁）。平均随访时间为7±2.9年（5 - 10年）。将末次随访时的临床结果和影像学矫正情况与术前值进行比较。进行了统计学分析，显著性设定为P < 0.01。
所有角度值在术前和术后值之间均发现有统计学意义的影像学改善。在末次随访时，视觉模拟评分（VAS）有显著改善（4.8对2；P < 0.01）。步行能力的改善也呈积极趋势。末次随访时未报告假关节病例。108只脚中有5只（4.6%）需要取出螺钉，2只脚（3.3%）内侧伤口愈合延迟。
SuAE联合TNA和中足软组织松解术是一种安全可行的手术方法，可为患有神经肌肉疾病和不可复位PVFD的患者提供良好的临床和影像学结果；该手术可改善足部稳定性，并发症数量有限。
IV级。
