Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, MO, USA.
Foot Ankle Int. 2024 Sep;45(9):962-971. doi: 10.1177/10711007241255116. Epub 2024 Jun 5.
Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the long-term effectiveness of the minimally invasive method for correcting CVT deformity in a large cohort of syndromic patients.
A single author recorded preoperative, 2-week postoperative, 1-year postoperative, and most recent radiographic measurements and complications for 25 patients treated with the minimally invasive method from 2006 to 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires were administered for 12 patients after January 1, 2015, when the institution began collecting PROMIS in all orthopaedic patients. Average follow-up was 55 months (13-111); 18 patients had minimum 24-month follow-up.
Forty feet in 25 patients were analyzed. The average preoperative lateral talar axis-first metatarsal base angle (TAMBA) was 68.7 ± 21.3 vs 12.1 ± 8.9 after initial surgical intervention ( < .0001). There was a statistically significant increase in the lateral TAMBA between the initial postoperative and final follow-up visits (13.0 vs 21.6, = .02). Radiographic recurrence of talonavicular deformity was noted in 12 feet (30.9%); 7 (15.55%) required corrective surgery. Larger preoperative lateral TAMBA was predictive of recurrence. Notably, patients with arthrogryposis experienced higher radiographic recurrence than other syndromic patients (45.0% vs 14.3%, = .0384). PROMIS scores were within population norms.
The study suggests that less than one-third of syndromic CVT patients experienced a radiographic recurrence of talonavicular deformity, with 15% requiring further surgical intervention at an average of 55 months following the initial procedure. A higher incidence of radiographic recurrence occurred in patients with distal arthrogryposis. These findings, along with the satisfactory patient-reported outcomes, suggest that the minimally invasive technique is an effective treatment method for syndromic CVT, underscoring the necessity for clinicians to provide detailed prognoses and consider more intensive follow-up for those at higher risk.
先天性垂直距骨（CVT）是一种罕见的刚性平足畸形，常见于有潜在神经综合征的患者。本研究旨在评估微创方法治疗综合征患者 CVT 畸形的长期疗效。
作者对 2006 年至 2021 年期间采用微创方法治疗的 25 例患者的术前、术后 2 周、术后 1 年和最近的影像学测量和并发症进行了单作者记录。2015 年 1 月 1 日起，该机构开始对所有矫形患者进行患者报告的结果测量信息系统（PROMIS）问卷调查，对 12 例患者进行了调查。平均随访时间为 55 个月（13-111 个月）；18 例患者的随访时间至少为 24 个月。
25 例患者的 40 只脚进行了分析。平均术前外侧距骨轴-第一跖骨基底角（TAMBA）为 68.7±21.3，初始手术干预后为 12.1±8.9（ < .0001）。初始术后和最终随访时的外侧 TAMBA 有统计学显著增加（13.0 vs 21.6， = .02）。12 只脚（30.9%）出现距舟骨畸形复发的影像学表现；7 只（15.55%）需要矫正手术。较大的术前外侧 TAMBA 与复发相关。值得注意的是，先天性关节挛缩症患者的影像学复发率高于其他综合征患者（45.0%比 14.3%， = .0384）。PROMIS 评分在人群正常值范围内。
该研究表明，不到三分之一的综合征性 CVT 患者出现距舟骨畸形的影像学复发，其中 15%的患者在初次手术后平均 55 个月需要进一步手术干预。在患有远端先天性关节挛缩症的患者中，影像学复发的发生率较高。这些发现以及令人满意的患者报告结果表明，微创技术是治疗综合征性 CVT 的有效方法，这突显了临床医生提供详细预后并考虑对高风险患者进行更强化随访的必要性。
