Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children.
Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children.
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DOI：
10.1007/s11832-014-0619-7
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发表时间：
2014-12
影响因子：
1.4
通讯作者：
Wirth, Thomas
中科院分区：
文献类型：
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作者：
De Pellegrin, Maurizio;Moharamzadeh, Desiree;Strobl, Walter Michael;Biedermann, Rainer;Tschauner, Christian;Wirth, Thomas
本研究的目的是描述一种距下关节外螺钉关节内固定术（SESA）技术用于矫正儿童柔性扁平足（FFF）并报告结果。从1990年到2012年，收集了485名在圣拉斐尔医院接受SESA的患者的数据。患者队列的平均年龄为11.5±1.81岁（范围5.0-17.9岁，中位数11.5岁）。纳入标准为FFF和明显的后足柔性外翻，排除标准为刚性平足。732例fff患者行SESA， 247例为双侧，238例为单侧。sesa负重前后x线角度分别为146°±7°和129°±5°，距骨倾斜角分别为43°±8°和25°±6°，跟骨节距分别为11°±6°和14°±5°（p <0.001）。所有数据均采用Student’s t检验进行统计学分析。398名患者的数据最终可用于分析。在93.7%的病例中，临床方面的改善和x线测量结果良好，无并发症，sesa后3个月足部功能正常，无需进一步手术。并发症发生率为6.3%，包括踝关节积液、腓骨肌挛缩痛和第四跖骨应力性骨折。76例患者（121英尺）在SESA术后平均2.9年取出螺钉后进行评估。该样本的角度测量没有统计学上的显著变化。根据我们近20年的经验，我们认为SESA是矫正FFF的最佳技术，因为它简单，可以快速完成，并且矫正效果来自螺钉的机械和本体感觉作用。手术指征必须准确。我们建议患者至少10岁，这样足部的所有生长潜力都能得到利用，并允许自发消退，从而避免过度治疗的可能性。
The aim of this study was to describe a subtalar extra-articular screw arthroereisis (SESA) technique for the correction of flexible flatfoot (FFF) in children and report the outcome. From 1990 to 2012, data were collected on 485 patients who underwent SESA at the San Raffaele Hospital. The average age of the patient cohort was 11.5 ± 1.81 years (range 5.0–17.9 years; median 11.5 years). Inclusion criteria were FFF and marked flexible hindfoot valgus, and the exclusion criterion was rigid flatfoot. SESA was performed in 732 cases of FFF—bilaterally in 247 patients and monolaterally in 238 patients. The values of the pre- and post-SESA weight-bearing X-ray angles were 146° ± 7° and 129° ± 5°, respectively, for the Costa-Bartani angle, 43° ± 8° and 25° ± 6°, respectively, for the talar inclination angle and 11° ± 6° and 14° ± 5°, respectively, for calcaneal pitch (p <0.001). All data were analysed statistically with Student’s t test. Data on 398 patients were ultimately available for analysis. In 93.7 % of cases the results were good in terms of improved clinical aspects and X-ray measurement, absence of complications, normal foot function 3 months post-SESA and no requirement for further surgery. The complication rate was 6.3 % and included ankle joint effusion, painful contracture of peroneal muscles and fourth metatarsal bone stress fractures. A sample of 76 patients (121 feet) were evaluated after screw removal, which occurred on average 2.9 years after SESA. The angle measurements of this sample showed no statistically significant modification. Based on our >20 years of experience, we believe that SESA is an optimal technique for the correction of FFF as it is simple and can be performed rapidly, and the corrective effect results from the screw’s mechanical and proprioceptive effect. The indication for surgery must be accurate. We suggest that the patient be at least 10 years of age in order that all of the foot’s growth potential can be utilized and to allow for spontaneous resolution and thereby avoid the possibility of over-treatment.