Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Sep;16(9):2242-2251. doi: 10.1111/os.14206. Epub 2024 Aug 26.
Midfoot osteotomy combined with Ilizarov methods of correction is a rarely reported treatment that is particularly well-suited for severe rigid pes cavus. The study aimed to assess the radiological and clinical results of patients who had been treated for rigid pes cavus using this method.
The study retrospectively analyzed the clinical and radiological data of 15 pes cavus in 12 patients who were corrected by midfoot osteotomy with Ilizarov external frame in our department from March 2020 to September 2022. Radiologic outcomes were measured using the Meary angle (MA), talus-first metatarsal angle (TM1A), calcaneal varus angle (CVA) and foot length with weight-bearing radiographs. Functional assessments were evaluated in terms of pain, function, and quality of life by using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), and 36-item Short Form Health Survey (SF-36). Additionally, the postoperative satisfaction of patients was investigated by a questionnaire. The clinical and radiological results were evaluated by a paired t-test.
All patients received plantigrade feet and pain relief. The mean follow-up was 33.1 ± 5.0 months (range from 25 to 41 months). The etiology included poliomyelitis (4), idiopathic (3), trauma (2), spina bifida (2) and tethered cord syndrome (1). The duration of gradual correction was 30.4 ± 10.6 days, and the external fixation time was 116.3 ± 33.3 days. The bony union rate was 100%. The VAS, AOFAS, and SF-36 scores significantly improved (p < 0.05). The MA, TM1A, and CVA were close to or reached the normal range postoperative (p < 0.01). The length of each foot was well preserved, which was increased more than 0.8 cm than preoperative. No major complications were reported except two cases of mildly hindfoot varus deformity. The results of the questionnaire showed that patients' satisfaction was 92% (11/12).
Midfoot osteotomy combined with Ilizarov external frame proved to be a reasonable procedure with satisfying mid-term results for the gradual correction of rigid pes cavus.
中足截骨联合伊利扎洛夫矫正方法是一种很少报道的治疗方法，特别适合严重僵硬性马蹄内翻足。本研究旨在评估采用该方法治疗僵硬性马蹄内翻足患者的放射学和临床结果。
本研究回顾性分析了 2020 年 3 月至 2022 年 9 月我科采用中足截骨联合伊利扎洛夫外固定架治疗的 12 例 15 例僵硬性马蹄内翻足患者的临床和放射学资料。采用 Meary 角（MA）、距骨第一跖骨角（TM1A）、跟骨内翻角（CVA）和负重位足部长度测量放射学结果。采用视觉模拟评分（VAS）、美国矫形足踝协会后足评分（AOFAS）和 36 项简明健康状况调查问卷（SF-36）评估疼痛、功能和生活质量。此外，通过问卷调查调查了患者的术后满意度。采用配对 t 检验评估临床和放射学结果。
所有患者均获得足底负重和缓解疼痛。平均随访 33.1±5.0 个月（25～41 个月）。病因包括脊髓灰质炎（4 例）、特发性（3 例）、创伤（2 例）、脊髓脊膜膨出（2 例）和脊髓栓系综合征（1 例）。逐渐矫正的时间为 30.4±10.6 天，外固定时间为 116.3±33.3 天。骨愈合率为 100%。VAS、AOFAS 和 SF-36 评分均显著改善（p<0.05）。MA、TM1A 和 CVA 术后接近或达到正常范围（p<0.01）。每只脚的长度都得到了很好的保留，比术前增加了 0.8 厘米以上。除 2 例轻度后足内翻畸形外，无其他重大并发症。问卷调查结果显示，患者满意度为 92%（11/12）。
中足截骨联合伊利扎洛夫外固定架逐渐矫正僵硬性马蹄内翻足是一种合理的方法，中期结果满意。
