Liang Zhenyang,Deng Huicheng,Wang Weicai,et al.Preliminary report on the effect of suture anchor in fixation of tibialis anterior tendon split and transfer in children with cerebral palsy and clubfoot[J].Journal of Clinical Pediatric Surgery,,():677-681.[doi:10.3760/cma.j.cn101785-202405068-013]
Preliminary report on the effect of suture anchor in fixation of tibialis anterior tendon split and transfer in children with cerebral palsy and clubfoot
- Keywords:
- Cerebral Palsy; Clubfoot Deformity; Tibialis Anterior Tendon; Surgical Procedures; Operative; Child
- Abstract:
- Objective To preliminarily explore the clinical efficacy of split anterior tibialis tendon transfer (SPLATT) with suture anchor fixation in the treatment of clubfoot in children with cerebral palsy.Methods A retrospective analysis was conducted on 18 cases of clubfoot in children with cerebral palsy who underwent SPLATT with suture anchor fixation at the Department of Pediatric Orthopedics,Hunan Loudi First People’s Hospital from June 2018 to January 2021.There were 12 males and 6 females;13 unilateral cases and 5 bilateral cases.Preoperative and postoperative gross motor function classification system (GMFCS) and tibialis anterior muscle strength were evaluated.The Kling evaluation criteria were used to assess orthopedic results and walking function.Results All 18 patients had complete follow-up.The average age at the time of surgery was 12.5±5.2 years,and the postoperative follow-up period was 26.3±5.4 months.No early postoperative complications such as tendon extrusion,tendon bowstringing,or incision infection occurred.According to the MRC muscle strength grading for the tibialis anterior muscle:preoperatively,15 cases were grade 5 and 3 cases were grade 4;postoperatively,15 cases were grade 5 and 3 cases were grade 4;the difference was not statistically significant (P>0.05).GFMCS grading:preoperatively,8 cases were grade 1,7 cases were grade 2,and 3 cases were grade 3;postoperatively,10 cases were grade 1,7 cases were grade 2,and 1 case was grade 3;the difference was not statistically significant (P>0.05).At the final follow-up,according to the Kling evaluation criteria for foot function:15 cases were excellent,and 3 cases were good.Conclusions Suture anchor fixation of the tibialis anterior tendon can achieve similar fixation results to traditional fixation methods.However,suture anchor fixation is simpler to perform,reduces soft tissue injury of the foot,and shortens operation time.
References:
[1] Bennet GC,Rang M,Jones D.Varus and valgus deformities of the foot in cerebral palsy[J].Dev Med Child Neurol,1982,24(4):499-503.DOI:10.1111/j.1469-8749.1982.tb13656.x.
[2] Chang CH,Albarracin JP,Lipton GE,et al.Long-term follow-up of surgery for equinovarus foot deformity in children with cerebral palsy[J].J Pediatr Orthop,2002,22(6):792-799.
[3] 应灏,王林.儿童痉挛性脑瘫外科治疗变迁与展望[J].临床小儿外科杂志,2022,21(6):501-504.DOI:10.3760/cma.j.cn101785-202202048-001. Ying H,Wang L.Historical modifications and future outlooks of surgery for cerebral palsy in children[J].DOI:10.3760/cma.j.cn101785-202202048-001.
[4] Wu KW,Huang SC,Kuo KN,et al.The use of bioabsorbable screw in a split anterior tibial tendon transfer:a preliminary result[J].J Pediatr Orthop B,2009,18(2):69-72.DOI:10.1097/bpb.0b013e328329429a.
[5] Hoffer MM,Reiswig JA,Garrett AM,et al.The split anterior tibial tendon transfer in the treatment of spastic varus hindfoot of childhood[J].Orthop Clin North Am,1974,5(1):31-38.
[6] Ponseti IV,Smoley EN.The classic:congenital club foot:the results of treatment.1963[J].Clin Orthop Relat Res,2009,467(5):1133-1145.DOI:10.1007/s11999-009-0720-2.
[7] Gasse N,Luth T,Loisel F,et al.Fixation of split anterior tibialis tendon transfer by Anchorage to the base of the 5th metatarsal bone[J].Orthop Traumatol Surg Res,2012,98(7):829-833.DOI:10.1016/j.otsr.2012.07.007.
[8] Kuo KN,Hennigan SP,Hastings ME.Anterior tibial tendon transfer in residual dynamic clubfoot deformity[J].J Pediatr Orthop,2001,21(1):35-41.DOI:10.1097/00004694-200101000-00009.
[9] Kling TF Jr,Kaufer H,Hensinger RN.Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity[J].J Bone Joint Surg Am,1985,67(2):186-194.
[10] Gaytán-Fernández S,Chaidez P,García-Galicia A,et al.[J].Acta Ortop Mex,2020,34(1):2-5.
[11] Vogt JC.Split anterior tibial transfer for spastic equinovarus foot deformity:retrospective study of 73 operated feet[J].J Foot Ankle Surg,1998,37(1):2-7.DOI:10.1016/s1067-2516(98)80003-3.
[12] Vogt JC,Bach G,Cantini B,et al.Split anterior tibial tendon transfer for varus equinus spastic foot deformity initial clinical findings correlate with functional results:a series of 132 operated feet[J].Foot Ankle Surg,2011,17(3):178-181.DOI:10.1016/j.fas.2010.05.009.
[13] Limpaphayom N,Chantarasongsuk B,Osateerakun P,et al.The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy:results and factors associated with a failed outcome[J].Int Orthop,2015,39(8):1593-1598.DOI:10.1007/s00264-015-2793-8.
[14] Visscher LE,Jeffery C,Gilmour T,et al.The history of suture anchors in orthopaedic surgery[J].Clin Biomech (Bristol,Avon),2019,61:70-78.DOI:10.1016/j.clinbiomech.2018.11.008.
[15] Goble EM,Somers WK,Clark R,et al.The development of suture anchors for use in soft tissue fixation to bone[J].Am J Sports Med,1994,22(2):236-239.DOI:10.1177/036354659402200214.
[16] Richmond JC,Donaldson WR,Fu F,et al.Modification of the Bankart reconstruction with a suture anchor.Report of a new technique[J].Am J Sports Med,1991,19(4):343-346.DOI:10.1177/036354659101900404.
[17] Kakihana M,Tochigi Y,Yamazaki T,et al.Suture anchor stabilization of symptomatic accessory navicular in adolescents:Clinical and radiographic outcomes[J].J Orthop Surg (Hong Kong),2020,28(2):1-6.DOI:10.1177/2309499020918949.
Memo
收稿日期:2024-5-27。
基金项目:湖南省卫健委科研项目(202104071292)
通讯作者:李宇,Email:187040296@qq.com