HyProCure治疗进行性扁平足畸形：距下关节制动术是一种好的手术方法吗？
HyProCure for progressive collapsing foot deformity: is subtalar arthroereisis a good procedure?
作者信息
Fu Shaoling, Wang Cheng, Zhang Shutao, Wu Chenglin, Wang Jiazheng, Shi Zhongmin
机构信息
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
出版信息
J Orthop Surg Res. 2024 Dec 26;19(1):885. doi: 10.1186/s13018-024-05406-3.
PURPOSE
To investigate the treatment outcomes of subtalar arthroereisis (SA) in progressive collapsing foot deformity (PCFD) patients, to assess the clinical efficacy in PCFD patients after HyProCure removal, and to evaluate safety and effectiveness of SA.
METHODS
In this retrospective study, 202 cases (213 feet) of PCFD patients treated with SA from June 2015 to December 2022 were selected. General data and surgical information were recorded, and clinical efficacy was evaluated through imaging and clinical indicators. Furthermore, for 36 patients (36 feet) who underwent secondary surgery to remove HyProCure, imaging and clinical evaluation indicators at 1-year post-removal were recorded. Complications were also documented.
RESULTS
The main complications were sinus tarsi pain (91.37%), with partial relief or disappearance of symptoms in some patients after conservative treatment. The imaging indicators improved significantly after SA (P < 0.01), and AOFAS score and VAS were significantly improved (P < 0.01), with a 100% excellent rate in patients one year after SA. For patients who removed HyProCure, the imaging indicators exhibited a significant improvement at preoperation and post-SA (P < 0.01), and no statistical difference was observed between post-SA and post-removal (P > 0.05). Regarding clinical indicators, AOFAS score at post-SA was difference compared with preoperation and post-removal separately (P < 0.01). However, the difference in VAS between preoperation and post-SA was not statistically significant (P > 0.05). Notably, there was a significant improvement at post-removal compared with post-SA (P < 0.01).
CONCLUSION
PCFD patients showed significant improvement in imaging and clinical evaluations after SA, with no significant flatfoot recurrence in patients who had HyProCure removed. Therefore, the application of HyProCure in SA can be considered a safe and effective surgical treatment for PCFD patients.
目的
探讨距下关节稳定术（SA）治疗进展性塌陷足畸形（PCFD）患者的治疗效果，评估HyProCure取出术后PCFD患者的临床疗效，并评价SA的安全性和有效性。
方法
本回顾性研究选取了2015年6月至2022年12月期间接受SA治疗的202例（213足）PCFD患者。记录一般资料和手术信息，并通过影像学和临床指标评估临床疗效。此外，对于36例行二次手术取出HyProCure的患者，记录取出术后1年的影像学和临床评估指标。同时记录并发症情况。
结果
主要并发症为跗骨窦疼痛（91.37%），部分患者经保守治疗后症状部分缓解或消失。SA术后影像学指标显著改善（P＜0.01），美国足踝外科协会（AOFAS）评分和视觉模拟评分（VAS）显著提高（P＜0.01），SA术后1年患者优良率达100%。对于取出HyProCure的患者，术前和SA术后影像学指标均显著改善（P＜0.01），SA术后与取出术后比较差异无统计学意义（P＞0.05）。临床指标方面，SA术后AOFAS评分与术前及取出术后比较差异均有统计学意义（P＜0.01）。然而，术前与SA术后VAS差异无统计学意义（P＞0.05）。值得注意的是，取出术后与SA术后比较有显著改善（P＜0.01）。
结论
PCFD患者SA术后影像学和临床评估均有显著改善，取出HyProCure的患者无明显扁平足复发。因此，HyProCure在SA中的应用可被认为是PCFD患者一种安全有效的手术治疗方法。
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