Mid-term Results of Subtalar Arthroereisis with Talar-Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain.
Mid-term Results of Subtalar Arthroereisis with Talar-Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain.
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使用 Talar-Fit 植入物治疗儿童柔性扁平足的距下关节松动术的中期结果，并确定辅助手术的效果和跗骨窦疼痛的危险因素
DOI：
10.1111/os.12864
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发表时间：
2021-03
影响因子：
2.1
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Wang S;Chen L;Yu J;Zhang C;Huang JZ;Wang X;Ma X
（i）报告使用Talar-Fit植入物治疗灵活扁平足患者的距下关节固定术的中期结局;（ii）比较关节固定术联合和不联合后续手术的临床和影像学结局，以研究关节固定术对结局的影响;（iii）分析与跗骨窦疼痛相关的风险因素，跗骨窦疼痛是关节固定术最常见的术后并发症。回顾性分析了2014年6月至2019年5月期间使用Talar-Fit植入物进行距下关节重建术的31名柔性扁平足儿童和青少年（46只脚）。将足部分为4个治疗组：（i）单独关节成形术，（ii）关节成形术伴腓肠肌后退，（iii）关节成形术伴Kidner手术，以及（iv）关节成形术伴腓肠肌后退和Kidner手术。根据美国足踝矫形协会（AOFAS）踝关节和后足评分评估临床功能。测量以下角度进行影像学评价：侧位片上的距骨-第一跖骨角、跟骨俯仰角和距骨斜角;前后位（AP）片上的距骨-第一跖骨角、距跟骨角和前后距舟覆盖角。使用配对Student t检验比较术前和术后角度测量值和AOFAS评分。进行Wilcoxon秩和检验以确定四个治疗组之间的结局差异。多因素Logistic回归分析用于分析跗骨窦疼痛的危险因素。P值<0.05为有统计学意义。足部的平均随访时间为32.8个月（范围：10-71个月）。AOFAS评分由术前的55.5 ± 14.5分提高到86.3 ± 9.9分（P < 0.001）。影像学结果比较显示，外侧距骨-第一跖骨角平均减小19.1° ± 11.9°跟骨俯仰角平均增加5.4° ± 3.4°（P < 0.001）距骨内倾角平均减小14.8° ± 9.9°（P < 0.001）（P < 0.001），AP距-第一跖骨角平均减小15.6° ± 10.3°前后距跟角平均减小7.2° ± 8.3°（P < 0.001）AP距舟覆盖角平均减小20.4° ± 9.0°（P < 0.001）。四个治疗组之间的AOFAS评分和AP和侧位视图上的所有角度测量值均无统计学显著差异。术后6周发生1例跌倒导致脱位，经非手术治疗。跗骨窦疼痛的发生率为13%，逻辑回归分析表明，植入物末端至跟骨外侧壁距离较长的患者发生跗骨窦疼痛的几率高38.8%。在使用Talar-Fit植入物单独或与其他植入物联合进行距下关节固定术治疗柔性扁平足的患者中，中期临床和影像学结果令人满意。接受距下关节固定术（单独或联合其他辅助手术）的灵活扁平足儿童和青少年的中期临床和影像学结果令人满意。植入物位置与术后跗骨窦疼痛相关。
To (i) report the mid‐term outcomes of subtalar arthroereisis using Talar‐Fit implant for the treatment of flexible flatfoot patients; (ii) compare clinical and radiographic outcomes between arthroereisis with and without adjunctive operative procedures to investigate the effects of adjuncts on the outcomes; and (iii) analyze the risk factors associated with sinus tarsi pain, which is the most common postoperative complication of arthroereisis. Thirty‐one flexible flatfoot children and adolescents (46 feet) treated with subtalar arthroereisis using Talar‐Fit implant from June 2014 to May 2019 were retrospectively analyzed. The feet were divided into four treatment groups: (i) arthroereisis alone, (ii) arthroereisis with gastrocnemius recession, (iii) arthroereisis with Kidner procedure, and (iv) arthroereisis with gastrocnemius recession and Kidner procedure. Clinical function was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score. The following angles were measured for radiographic evaluation: talar‐first metatarsal angle, calcaneal pitch angle, and talar declination angle on the lateral view; and talar‐first metatarsal angle, talocalcaneal angle, and anteroposterior talonavicular coverage angle on the anteroposterior (AP) view. The paired Student's t‐test was used to compare the pre‐ and postoperative angular measurements and AOFAS scores. The Wilcoxon rank‐sum test was undertaken to determine the outcome differences among four treatment groups. Multivariate logistic regression analysis was used to analyze risk factors for sinus tarsi pain. P value <0.05 is considered statistically significant. The mean follow‐up of the feet was 32.8 months (range, 10–71 months). The mean AOFAS score significantly improved from 55.5 ± 14.5 preoperatively to 86.3 ± 9.9 (P < 0.001). Comparison of radiographic outcomes showed that the lateral talar‐first metatarsal angle decreased by a mean of 19.1° ± 11.9° (P < 0.001), the calcaneal pitch angle increased by a mean of 5.4° ± 3.4° (P < 0.001), the talar declination angle decreased by a mean of 14.8° ± 9.9° (P < 0.001), the AP talar‐first metatarsal angle decreased by a mean of 15.6° ± 10.3° (P < 0.001), the AP talocalcaneal angle decreased by a mean of 7.2° ± 8.3° (P = 0.001), and the AP talonavicular coverage angle decreased by a mean of 20.4° ± 9.0° (P < 0.001). There were no statistically significant differences with regard to AOFAS score and all angle measurements on both the AP and lateral views among the four treatment groups. There was one dislocation case caused by a fall 6 weeks after surgery, which was treated nonoperatively. The incidence of sinus tarsi pain was 13% and logistic regression analysis indicated that patients with a longer distance from the tail end of the implant to the lateral calcaneal wall had 38.8% greater odds of developing sinus tarsi pain. The mid‐term clinical and radiographic results were satisfactory in patients who underwent the subtalar arthroereisis procedure using Talar‐Fit implant, alone or in combination with other adjuncts, for the treatment of flexible flatfoot. The mid‐term clinical and radiographic results were satisfactory in flexible flatfoot children and adolescents who underwent subtalar arthroereisis, alone or in combination with other adjunctive procedures. Implant position was associated with postoperative sinus tarsi pain.
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影响因子：
1.4
作者：
De Pellegrin, Maurizio;Moharamzadeh, Desiree;Strobl, Walter Michael;Biedermann, Rainer;Tschauner, Christian;Wirth, Thomas
通讯作者：
Wirth, Thomas
影响因子：
2.7
作者：
Gutiérrez, PR;Lara, MH
通讯作者：
Lara, MH
影响因子：
2.1
作者：
Duan, Xiao-jun;Fan, Hua-quan;Yang, Liu
通讯作者：
Yang, Liu
影响因子：
0.6
作者：
Highlander, Peter;Sung, Wenjay;Weil, Lowell, Jr.
通讯作者：
Weil, Lowell, Jr.
影响因子：
2.5
作者：
Indino, Cristian;Villafane, Jorge Hugo;Usuelli, Federico Giuseppe
通讯作者：
Usuelli, Federico Giuseppe