Mou Xiaping,Ji Yong,Liao Wei,et al.Mid-term comparative study of lateral column lengthening and extraosseous talotarsal stabilization for the treatment of flexible flatfoot in children[J].Journal of Clinical Pediatric Surgery,2022,21(01):63-68.[doi:10.3760/cma.j.cn.101785-202101049-012]
外侧柱延长术与距下关节制动术治疗儿童柔软性平足症的中期疗效比较
- Title:
- Mid-term comparative study of lateral column lengthening and extraosseous talotarsal stabilization for the treatment of flexible flatfoot in children
- Keywords:
- Flexible Flatfoot/SU; Lateral Column Lengthening; Extraosseous Talotarsal Stabilization; Treatment Outcome; Follow-Up Studies; Child
- 摘要:
- 目的 对比外侧柱延长术与距下关节制动术治疗儿童柔软性平足症的中期疗效。方法 2012年6月至2016年6月，简阳市人民医院骨科收治儿童柔软性平足症患者33例（38足）。采取外侧柱延长术（lateral column lengthening，LCL）治疗19例（22足），为LCL组，其中男12例，女7例；年龄（9.5±2.3）岁。采取距下关节制动术（extraosseous talotarsal stabilization，EOTTS）治疗14例（16足），为EOTTS组，其中男9例，女5例；年龄（10.2±2.1）岁。测量两组手术前及末次随访时前、后位X线片上距骨第1跖骨角（talar 1 metatarsal angle，T1MT）、距骨第2跖骨角（talar 2 metatarsal angle，T2MT）、距舟覆盖角（talonavicular coverage angle，TCA）、跟骨倾斜角（Pitch角）、跟骨距骨角（Kite角），并比较两组手术前及末次随访时VAS评分、Maryland评分、AOFAS踝与后足功能评分以及Viladot足印分级。结果 LCL组术后随访36~66个月，平均 （44.4±2.2）个月；EOTTS组术后随访38~74个月，平均（47.5±1.7）个月。与LCL组比较，EOTTS组手术时间更短[（45.12±10.15）min vs.（80.47±15.28）min]，失血量更少[（20.12±5.90）mL vs.（50.13±10.58）mL]，切口长度更短[（1.54±0.86）cm vs.（4.18±1.55）cm]，住院时间也更短[（5.25±0.53）d vs.（8.07±2.59）d]，差异均有统计学意义（P< 0.05）。LCL组出现并发症2例，EOTTS组出现并发症1例，两组并发症发生率差异无统计学意义（χ2=0.097，P>0.05）。至末次随访时，两组T1MT角、T2MT角、TCA角、Meary角、Pitch角、Kite角均较术前有改善（P<0.05）；两组VAS评分及Viladot足印分级均较术前降低（P<0.05），Maryland评分和AOFAS踝与后足功能评分较术前提高（P<0.05）。结论 外侧柱延长术治疗儿童柔软性平足症的总体疗效与距下关节制动术相当，都能取得满意的中期疗效；后者具有手术时间短、创伤小及住院时间短等优点，是一种较有应用前景的微创手术方式。但需根据患儿病因、临床症状及影像学评价结果综合选择，并辅以其他手术加强疗效。
- Abstract:
- Objective To compare the mid-term effects of lateral column lengthening (LCL) and extraosseous talotarsal stabilization (EOTTS) in treating children with flexible flatfoot. Methods A retrospective review was led on 33 pediatric patients (38 feet) with flexible flatfoot from June 2012 to June 2016.Patients were divided into two groups.The LCL group:19 cases (22 feet) including 12 males, 7 females, with the mean age 9.5±2.3 years.The EOTTS group:14 cases (16 feet) including 9 males and 5 females with the mean age 10.2±2.1 years.Anteroposterior X ray of talar-to-first metatarsal angle (T1MT), talar-to-second metatarsal angle (T2MT) talonavicular coverage angle (TCA), calcaneal pitch angle (Pitch angle) and talo-calcaneal angle (Kite angle) were measured.The visual analogue scale (VAS) score, Maryland score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, Viladot’s grading of flatfoot on footprint were compared before operation and at the final follow-up between the two groups. Results The mean follow-up of LCL and EOTTS groups were (44.4±2.2)(36-66) months and (47.5±1.7)(38-74) months respectively.Significant inter-group differences in operation time, intraoperative blood loss, length of incision and length of stay were noted (P<0.05).There were two patients in LCL group and one patient in EOTTS had complications, with no statistical differences (χ2=0.0972, P>0.05).The angles of T1MT, T2MT, TCA, Meary, Pitch and Kite were significantly improved (P<0.05) at the last follow-up compared with those before the operation.VAS score and Viladot’s grading of flatfoot on footprint decreased (P<0.05), while Maryland score and AOFAS ankle and hindfoot score increased (P<0.05) at the final follow-up visit compared with those before operation in each group. Conclusion To apply LCL in treating children with flexible foot has the same effect as EOTTS.Both approaches can obtain a satisfactory outcome in the mid-term, yet the latter is superior with shorter operation time, small trauma, less bleeding and shorter length of stay, which is an ideal minimally invasive technique.However, additional operations should be considered to strengthen the therapeutic effect based on patient’s etiology, clinical symptom and imaging evaluation.
参考文献/References:
[1] Carr JB 2nd,Yang S,Lather LA.Pediatric Pes Planus:A State-of-the-Art Review[J].Pediatrics,2016,137(3):e20151230.DOI:10.1542/peds.2015-1230.
[2] Matsumoto T,Nakada I,Juji T,et al.Radiologic patterning of hallux deformity in rheumatoid arthritis and its relationship to flatfoot[J].J Foot Ankle Surg,2016,55(5):948-954.DOI:10.1053/j.jfas.2016.04.011.
[3] Marengo L,Canavese F,Mansour M,et al.Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients[J].Eur J Orthop Surg Traumatol,2017,27(7):989-996.DOI:10.1007/s00590-017-1909-9.
[4] Akimau P,Flowers M.Medium term outcomes of planovalgus foot correction in children using a lateral column lengthening approach with additional procedures’a la carte’[J].Foot Ankle Surg,2014,20(1):26-29.DOI:10.1016/j.fas.2013.08.005.
[5] Bouchard M,Mosca VS.Flatfoot deformity in children and adolescents:surgical indications and management[J].J Am Acad Orthop Surg,2014,22(10):623-632.DOI:10.5435/JAAOS-22-10-623.
[6] Graham ME,Jawrani NT,Chikka A.Extraosseous talotarsal stabilization using HyProCure?in adults:a 5-year retrospective follow-up[J].J FootAnkle Surg,2012,51(1):23-29.DOI:10.1053/j.jfas.2011.10.011.
[7] Turner NM,van de Leemput AJ,Draaisma JM,et al.Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills[J].Med Educ,2008,42(5):503-511.DOI:10.1111/j.1365-2923.2007.02950.x.
[8] Sanders R,Fortin P,DiPasquale T,et al.Operative treatment in 120 displace intraarticular calcaneal fractures.Results using a prognostic computed tomography scan classification[J].Clin Orthop Relat Res,1993,290:87-95.
[9] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15:349-353.
[10] Coster MC,Rosengron BE,Bremander A,et al.Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain,improves function and health related quality of life[J].Foot Ankle Surg,2015,21(4):286-289.DOI:10.1016/j.fas.2015.04.003.
[11] 蒙雨,唐学阳,刘利君.儿童柔软型扁平足的治疗进展[J].临床小儿外科杂志,2018,17(5):390-393.DOI:10.3969/j.issn.1671-6353.2018.05.017. Meng Y,Tang XY,Liu LJ.Advances in the treatment of pediatric flexible flatfoot[J].J Clin Ped Sur,2018,17(5):390-393.DOI:10.3969/j.issn.1671-6353.2018.05.017.
[12] Metcalfe SA,Bowling FL,Reeves ND.Subtalar joint arthroereisis in the management of pediatric flexible flatfoot:a critical review of the literature[J].Foot Ankle Int,2011,32(12):1127-1139.DOI:10.3113/FAI.2011.1127.
[13] Bernasconi A,Lintz F,Sadile F.The role of arthroereisis of the subtalar joint for flatfoot in children and adults[J].EFORT Open Rev,2017,2(11):438-446.DOI:10.1302/2058-5241.2.170009.
[14] Pavone V,Costarella L,Testa G,et al.Calcaneo-stop procedure in the treatment of the juvenile symptomatic flatfoot[J].J FootAnkle Surg,2013,52(4):444-447.DOI:10.1053/j.jfas.2013.03.010.
[15] Fernández de Retana P,Alvarez F.Subtalar arthroereisis in pediatric flatfoot reconstruction[J].Foot AnkleClin,2010,15:323-335.DOI:10.1016/j.fcl.2010.01.001.
备注/Memo
收稿日期:2022-02-13。
通讯作者:唐康来,Email:tangkanglai@hotmail.com