Daumas L, Filipe G, Carlioz H
Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Trousseau, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(6):527-37.
The aim of this study was to emphasize the anatomical particularities of congenital vertical talus. We propose a one stage operative procedure adapted to the deformities.
A retrospective study of 24 children with congenital vertical talus was conducted. An etiology was observed in 58 per cent of cases and 42 per cent were considered as idiopathic. From a radiological analysis of 39 feet, we precise the anatomical particularities. We used anteroposterior and lateral X-ray and lateral stress views with maximal plantar and dorsal flexion. Most of the lesions were localized in the midtarsal joint. The irreducibility of the talonavicular dislocation is the predominant lesion. It is usually associated with a disorientation of the cubocalcaneal joint. The articular surfaces are disorganized with a dorsal orientation. There is a variable amount of equinus deformity in the hindfoot. However the talocalcaneal divergence angle is nearly normal. The forefoot is most of the times in eversion but sometimes in inversion.
All children were treated initially by physiotherapy. We recommend operative treatment for them between one to two years old. After a soft tissue release, the talonavicular dislocation and the hind foot equinus deformity is reduced simultaneously. The subtalar joint is respected and not opened. Retracted tendons may be an obstacle to the reduction. They must be lengthened if necessary especially the Achilles tendon, the peronei, the extensors and the tibialis anterior. Reduction is maintained by a K wire transfixing the midtarsal joint.
Clinical results were difficult to evaluate. Out of 24 operated feet, a satisfactory outcome had been achieved in 15 feet. All were plantigrad and 18 had a good cosmetically aspect. The only bad result concerned an old case which was not operated by this technique.
Conservative treatment is usually unsuccessful in congenital vertical talus. Numerous procedures have been advocated for the surgical correction of this deformity. Some authors advised excision of the navicular, full open peritalar release or extraarticular talocalcaneal arthrodesis. These are often extensive procedures and most are performed in two stages. Recently, one stage operative procedure was proposed. It allows a good correction with the respect of the subtalar joint and a lower risk of talus avascular necrosis. Furthermore it is more adapted to the deformity with a less extensive scar and a better respect of the anatomy.
本研究旨在强调先天性垂直距骨的解剖学特点。我们提出一种针对畸形的一期手术方法。
对24例先天性垂直距骨患儿进行回顾性研究。58%的病例观察到病因，42%被认为是特发性的。通过对39只足的放射学分析，我们明确了解剖学特点。我们使用前后位和侧位X线以及最大跖屈和背屈位的侧位应力位片。大多数病变位于中跗关节。距舟关节脱位不可复位是主要病变。它通常与跟骰关节方向紊乱相关。关节面紊乱且背侧移位。后足存在不同程度的马蹄足畸形。然而距跟分离角基本正常。前足多数时候外翻，但有时内翻。
所有患儿最初均接受物理治疗。我们建议在1至2岁时对他们进行手术治疗。在软组织松解后，同时复位距舟关节脱位和后足马蹄足畸形。保留距下关节不切开。回缩的肌腱可能是复位的障碍。如有必要，必须延长肌腱，尤其是跟腱、腓骨肌腱、伸肌腱和胫前肌腱。通过一根克氏针固定中跗关节来维持复位。
临床结果难以评估。在24只接受手术的足中，15只获得了满意的结果。所有足均为平足，18只外观良好。唯一的不良结果涉及一例未采用该技术手术的老病例。
先天性垂直距骨的保守治疗通常不成功。已经提出了许多用于手术矫正这种畸形的方法。一些作者建议切除舟骨、完全开放的距周松解或关节外距跟关节融合术。这些通常是广泛的手术，大多数分两期进行。最近，提出了一期手术方法。它能在保留距下关节的情况下实现良好矫正，且距骨缺血性坏死风险较低。此外，它更适合畸形，瘢痕较小且更尊重解剖结构。
