Therapeutic Outcomes of Kalix II in Treating Juvenile Flexible Flatfoot
Therapeutic Outcomes of Kalix II in Treating Juvenile Flexible Flatfoot
复制标题
Kalix II 治疗青少年柔性扁平足的治疗效果
DOI：
10.1111/os.12309
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发表时间：
2017-02-01
影响因子：
2.1
通讯作者：
Zhang, Qiang
中科院分区：
文献类型：
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作者：
Cao, Le;Miao, Xu-dong;Zhang, Qiang
目的：方法：回顾性分析2008年1月至2012年9月20例青少年有症状的柔性扁平足（27足）接受Kalix II植入手术的资料。通过使用标准的10分视觉模拟量表（VAS）评估和随访日常活动期间的疼痛，并使用美国矫形足和踝关节协会（AOFAS）踝关节和后足评分系统以及前后距骨-第一跖骨角、外侧距骨-第一跖骨角、跟骨俯仰角、通过测量X线片上的距骨斜角和距骨斜角来评价治疗效果。要求患者在最后随访时将手术结果分级为优、良、一般或差。数据表示为平均值+/-标准差（SD）。配对Student t检验用于比较每只脚的术前和术后角度测量值、VAS评分和AOFAS评分。结果：患者平均年龄12.1岁（7-16岁），左足16只，右足11只。所有患者均完成随访，平均随访时间为28.1个月（范围，23-60个月）。11只足在分离副舟状骨后，采用距下关节固定结合胫后肌腱终点重建的方法进行治疗。术后3个月，1只足因从内翻位跌倒，距下关节固定装置移位，保守治疗失败后更换为新装置。平均VAS评分从术前5.6 ± 0.5降至1.2 ± 0.2（P < 0.001），平均AOFAS后足和踝评分从术前71.1 ± 6.1改善至88.1 ± 6.3（P < 0.001）。术前和术后测量的每个放射学变量之间的差异具有统计学意义（P < 0.001）。影像学测量结果的比较显示，前后距-第一跖骨（Meary）角平均降低12.8度+/- 1.5度，外侧距-第一跖骨（Meary）角平均降低15.4度+/- 1.3度，跟骨俯仰角平均增加-2.1度+/- 0.7度，距骨斜角平均减小17.9 ° ± 2.8 °。结论：Kalix II距下关节固定联合副舟状骨分离及胫后肌腱重建是治疗青少年灵活性扁平足的有效方法。
Objectives: To evaluate the therapeutic outcomes with Kalix II subtalar arthroereisis in sinus tarsi for juvenile flexible flatfoot.Methods: A retrospective analysis of the data of 20 juveniles with symptomatic flexible flatfoot (27 feet) who underwent the Kalix II implant procedure from January 2008 to September 2012 was performed. The pain during daily activities was assessed and followed up by use of a standard 10-point visual analog scale (VAS), and function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, and anteroposterior talar-first metatarsal angle, lateral talar-first metatarsal angle, calcaneal pitch angle, and talar declination angle at X-ray film were measured to assess the therapeutic outcomes. Patients were asked to grade the result of the procedure as excellent, good, fair, or poor at latest follow-up. The data was expressed as mean +/- standard deviation (SD). A paired Student's t-test was used for comparisons of the preoperative and postoperative angular measurements for each foot, VAS scores, and AOFAS scores. In all tests, P < 0.05 was considered statistically significant.Results: The mean age of the patients was 12.1 years (range, 7-16 years), and 16 left feet and 11 right feet were involved. All patients finished the follow-up with a mean period of 28.1 months (range, 23-60 months). Eleven feet were treated with subtalar arthroereisis combined with reconstruction of the end point of the posterior tibialis tendon after dissection of the accessory scaphoid. The subtalar arthroereisis device displaced in 1 foot due to a fall from the inversion position 3 months after surgery, and was replaced by a new device after the failure of conservative treatment. The mean VAS score decreased from 5.6 +/- 0.5 preoperatively to 1.2 +/- 0.2 (P < 0.001), and the mean AOFAS hindfoot and ankle score improved from 71.1 +/- 6.1 preoperatively to 88.1 +/- 6.3 (P < 0.001). Differences between preoperative and postoperative measurements for each radiographic variable were statistically significant (P < 0.001). Comparison of radiographic measurements showed that the anteroposterior talar-first metatarsal (Meary) angle decreased by a mean of 12.8 degrees +/- 1.5 degrees, the lateral talar-first metatarsal (Meary) angle decreased by a mean of 15.4 degrees +/- 1.3 degrees, the calcaneal pitch angle increased by a mean of -2.1 degrees +/- 0.7 degrees, and the talar declination angle decreased by a mean of 17.9 degrees +/- 2.8 degrees. Overall, 12 patients rated the result as excellent, 6 as good, and 2 as fair.Conclusion: The application of Kalix II in subtalar arthroereisis combined with dissection of accessory scaphoid and reconstruction of posterior tibialis tendon is an effective therapy for flexible juvenile flatfoot.