Mosca Vincent S, Masquijo Javier
Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina.
J Pediatr Soc North Am. 2024 Apr 4;7:100048. doi: 10.1016/j.jposna.2024.100048. eCollection 2024 May.
Assessment and management of talocalcaneal middle facet tarsal coalitions present a complex orthopaedic challenge. Various studies have attempted to establish guidelines for surgical intervention based on coalition size and hindfoot alignment. Our paper reviews the historical focus on coalition size, suggesting instead that posterior facet health is a more appropriate consideration for surgical decision making. Additionally, we challenge the traditional method for evaluating hindfoot alignment and propose a more accurate evaluation method. This critical review intends to highlight flaws in historical literature, aiming to trigger a reevaluation of the criteria for surgical intervention in talocalcaneal tarsal coalitions and promote future research studies driven by data and scientifically validated methodologies.
(1)This paper challenges conventional criteria for surgical decision-making in talocalcaneal tarsal coalitions.(2)The authors advocate for a shift in focus, proposing that posterior facet health, rather than coalition size, should be the determinant for resection.(3)Wilde's method for evaluating hindfoot alignment is challenged as being subjective and susceptible to influence by the height/vertical length of the calcaneus visible on individual coronal CT scan slices.(4)The authors propose a more precise assessment of hindfoot alignment using the anatomic axis of the calcaneus, acknowledging the need for further validation.(5)Establishing scientifically tested criteria for posterior facet health/thickness and hindfoot valgus deformity through research will improve consistency in surgical decision making and, thereby, improve patient outcomes.
V.
距跟中关节面跗骨联合的评估与处理是一项复杂的骨科挑战。各种研究试图基于联合的大小和后足对线来制定手术干预指南。我们的论文回顾了以往对联合大小的关注，相反，我们认为后关节面的健康状况是手术决策中更合适的考虑因素。此外，我们对评估后足对线的传统方法提出质疑，并提出一种更准确的评估方法。这篇批判性综述旨在突出历史文献中的缺陷，旨在引发对距跟跗骨联合手术干预标准的重新评估，并推动未来由数据和科学验证方法驱动的研究。
（1）本文对距跟跗骨联合手术决策的传统标准提出质疑。（2）作者主张转变关注点，提出后关节面的健康状况而非联合大小应作为切除的决定因素。（3）怀尔德评估后足对线的方法受到质疑，因为它主观且易受个体冠状位CT扫描切片上可见的跟骨高度/垂直长度的影响。（4）作者提出使用跟骨的解剖轴对后足对线进行更精确的评估，同时承认需要进一步验证。（5）通过研究建立后关节面健康状况/厚度和后足外翻畸形的科学测试标准，将提高手术决策的一致性，从而改善患者预后。
V级。
