Nasreddine Adam, Dunham Alexandra, Mo Michelle, Miller Patricia E, Mahan Susan T
Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA.
Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD.
J Pediatr Orthop. 2025 May 1. doi: 10.1097/BPO.0000000000003004.
A subset of patients with flexible pediatric pes planovalgus (PPV) will have recalcitrant symptoms and functional impairment despite maximizing nonoperative methods and seeking surgical care. The primary aim of this study was to compare the clinical course and radiographic improvement including final alignment for patients who underwent the minimally invasive corrective subtalar extra-articular screw arthroereisis (SESA) technique compared with the traditional modified Evans reconstruction (MER) technique for flexible PPV correction.
Forty-five feet in 31 PPV patients aged 10 to 19 years treated at a single institution with (1) SESA +/- Vulpius or accessory navicular or tarsal coalition excision (22 feet) or (2) MER +/- Vulpius (23 feet) from 2010 to 2022 were identified. Patients with no weight-bearing postoperative x-rays were excluded. Comprehensive preoperative and postoperative radiographic measurements were obtained from standing radiographs. Radiographic outcomes were evaluated across treatment groups using noninferiority analysis. Comparisons in clinical characteristics were conducted using mixed-effects regression modeling to account for the correlation between bilateral measurements within the same patient.
Surgery was performed at an average age of 13.7 years (SD, 1.9); the cohort was 53% male. There were no differences in age, BMI, or laterality between the SESA and MER cohorts. The SESA cohort had a significantly shorter operative time compared with MER (51 vs. 167 min; P<0.001). One patient in the MER cohort required a return to the operating room for hardware removal in the setting of pseudoarthrosis, and another for a buried pin. Time to weightbearing in the SESA cohort was a median 3 weeks earlier than the MER cohort (P=0.004). The SESA procedure was found to be noninferior to MER with respect to postoperative radiographic alignment as well as in the improvement in alignment from preoperative to postoperative measurement (all P<0.05).
For painful pediatric pes planovalgus (PPV), subtalar extra-articular screw arthroereisis (SESA) offers a less invasive approach with noninferior outcomes compared with modified Evans reconstruction (MER). Our study found similar radiographic improvements and deformity correction in adolescents treated with SESA versus MER, along with shorter procedures and earlier weightbearing. No major complications were observed. Long-term follow-up and patient-reported outcome studies are needed, especially postscrew removal.
Therapeutic case-control study, level III.
一部分柔性小儿扁平足外翻（PPV）患者，即便已将非手术方法最大化并寻求手术治疗，仍会出现顽固性症状和功能障碍。本研究的主要目的是比较接受微创距下关节外螺钉关节造形术（SESA）技术与传统改良埃文斯重建术（MER）技术矫正柔性PPV的患者的临床病程和影像学改善情况，包括最终对线情况。
确定了2010年至2022年在单一机构接受治疗的31例10至19岁PPV患者的45只足，其中（1）22只足接受SESA±Vulpius或副舟骨或跗骨联合切除术，（2）23只足接受MER±Vulpius。排除术后无负重X线片的患者。从站立位X线片中获得全面的术前和术后影像学测量数据。使用非劣效性分析评估各治疗组的影像学结果。使用混合效应回归模型进行临床特征比较，以考虑同一患者双侧测量之间的相关性。
手术平均年龄为13.7岁（标准差，1.9）；队列中男性占53%。SESA组和MER组在年龄、BMI或侧别方面无差异。与MER组相比，SESA组的手术时间明显更短（51分钟对167分钟；P<0.001）。MER组有1例患者因假关节需要返回手术室取出内固定物，另1例因埋入的钢针返回手术室。SESA组开始负重的时间比MER组早3周（中位数）（P=0.004）。发现SESA手术在术后影像学对线以及术前到术后测量的对线改善方面不劣于MER（所有P<0.05）。
对于疼痛性小儿扁平足外翻（PPV），距下关节外螺钉关节造形术（SESA）与改良埃文斯重建术（MER）相比，提供了一种侵入性较小的方法，且结果不劣。我们的研究发现，接受SESA与MER治疗的青少年在影像学改善和畸形矫正方面相似，同时手术时间更短，负重更早。未观察到重大并发症。需要进行长期随访和患者报告结局研究，尤其是在取出螺钉后。
治疗性病例对照研究，III级。
