Wu Jiangyan,Tan Qian,Yang Ge,et al.Extraarticular double osteotomy of the first ray for pediatric pes cavus[J].Journal of Clinical Pediatric Surgery,,21():719-724.[doi:10.3760/cma.j.cn101785-202208003-004]
Extraarticular double osteotomy of the first ray for pediatric pes cavus
- Keywords:
- Talipes Cavus/SU; Osteotomy/MT; Treatment Outcome; Child
- Abstract:
- Objective Pediatric pes cavus is a complex deformity caused mostly by flexion of the forefoot,especially on the first ray (cuneiform&metatarsal).The aim of this study was correcting rigid pes cavus deformity of the first metatarsal ray stepwise and observing clinical efficacy through joint sparing extraarticular double osteotomy and soft tissue surgery.This procedure is different from most other cross-joint osteotomies or fusions.Methods From July 2017 to July 2019,clinical data were retrospectively reviewed for 11 children with 18 feet of pes cavus.The average age was 8.5(6.2-12.5) years.After preoperative clinical and radiological evaluations,extraarticular double osteotomy of the first ray,soft tissue releasing and muscle balance were performed along with closed wedge osteotomy of proximal dorsal end of the first metatarsal bone,open medial wedge osteotomy,foot plantar incision,peroneus longus tendon transferring to peroneus brevis tendon and Achilles tendon extension.The efficacy was evaluated by Wicart grading system.Results Appearance,weight bearing and walking function of 18 feet improved markedly without pain.Osteotomy was required for calcaneal varus in two feet (n=2).The mean Meary angle declined from (34.4°±8.5°) to (11.2°±2.4°)(P<0.05),the mean calcaneal axis improved from-6.1°±1.3° to 4.2°±0.8°(P<0.05),the mean Pitch angle decreased from (45.2°±6.4°) to (22.4°±5.4°)(P<0.05) and the mean Hibb angle spiked from (121.4°±11.2°) to (145.8°±10.7°)(P<0.05).The mean follow-up period was 32(24-48) months.The outcome was excellent (13 feet),fair (3 feet) and decent (2 feet).Conclusion For pes cavus in children,extraarticular double osteotomy on the first ray while retaining joint may avoid joint fusion.The short-term efficacy is satisfactory while long-term outcomes require further observations.Cubotomy and calcaneal osteotomy are necessary for children with fixed forefoot adduction and varus and calcaneal valgus deformity.
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Memo
收稿日期:2022-8-1。
基金项目:国家临床重点专科建设项目-湖南省儿童医院小儿外科(湘卫医发[2022]2号)
通讯作者:梅海波,Email:meihaibo@sohu.com