PDF(Pubmed)
Abstract：
BACKGROUND: While surgical stabilisation of the subtalar joint (arthroeresis) in children remains controversial in the USA, it is widely practised worldwide, with reportedly good outcomes. We are presenting a series of patients who met our criteria for calcaneal lengthening, but whose parents chose the less invasive option of talo-tarsal stabilisation (TTS). The goal of this surgery was to forestall or prevent hindfoot osteotomy.
METHODS: With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6-15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2).
RESULTS: In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary.
CONCLUSIONS: TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus.
METHODS: IV retrospective case series.
UNASSIGNED: Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168-171.
METHODS: With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6-15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2).
RESULTS: In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary.
CONCLUSIONS: TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus.
METHODS: IV retrospective case series.
UNASSIGNED: Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168-171.
摘要：
背景：虽然在美国，儿童距下关节（关节置换）的手术稳定性仍存在争议，它在世界范围内广泛使用，据报道，结果很好。我们介绍了一系列符合我们跟骨延长标准的患者，但他们的父母选择了侵入性较小的治疗方法-talo骨稳定（TTS）。该手术的目的是阻止或防止后足截骨术。
方法：经IRB批准，我们对32例患者(60英尺)进行了回顾性研究，他们接受了TTS治疗柔性平面外翻畸形，并进行了至少1年的随访。大多数人的病因是特发性的，其中一些是神经源性或综合征。年龄范围为6-15岁；年轻患者有神经肌肉病因或潜在综合征。伴随手术包括经皮跟腱延长术（33英尺），Kidner（9英尺）和踝关节外翻的引导生长（2）。
结果：在固定后的早期阶段，腓骨痉挛发生在4例（6英尺）。这通过在三名患者的腓骨短肢中注射肉毒杆菌来解决，并且需要在一名患者中将腓骨短肢转移到腓骨长骨。在后续行动中,1至4.5年不等，保留了50个植入物（83.4％），患者报告了令人满意的结果。从今以后,这些患者将在p.r.n.基础上进行监测。由于挥之不去的不适,1例患者重新定位植入物,5例患者移除植入物(10ft=16.6%).在进一步的后续行动中，这些患者没有表现出复发性畸形。因此,没有必要通过截骨和/或跟骨延长进行后续抢救。
结论：TTS治疗有症状的扁平足，与所示的其他程序相结合，与目前更普遍接受的内侧移位截骨或跟骨延长方法相比，具有优势。1年的结果是是否需要进一步治疗的良好预测。与其他手术管理方法相比，这是一个更简单和首选的选择，根据我们的经验,消除了截骨或跟骨延长的需要。
方法：IV回顾性病例系列。
未经批准：StevensP,兰开斯特A,KhwajaA.Talar-tarsal稳定：目标和初步成果。策略创伤肢体重建2021；16(3)：168-171。
方法：经IRB批准，我们对32例患者(60英尺)进行了回顾性研究，他们接受了TTS治疗柔性平面外翻畸形，并进行了至少1年的随访。大多数人的病因是特发性的，其中一些是神经源性或综合征。年龄范围为6-15岁；年轻患者有神经肌肉病因或潜在综合征。伴随手术包括经皮跟腱延长术（33英尺），Kidner（9英尺）和踝关节外翻的引导生长（2）。
结果：在固定后的早期阶段，腓骨痉挛发生在4例（6英尺）。这通过在三名患者的腓骨短肢中注射肉毒杆菌来解决，并且需要在一名患者中将腓骨短肢转移到腓骨长骨。在后续行动中,1至4.5年不等，保留了50个植入物（83.4％），患者报告了令人满意的结果。从今以后,这些患者将在p.r.n.基础上进行监测。由于挥之不去的不适,1例患者重新定位植入物,5例患者移除植入物(10ft=16.6%).在进一步的后续行动中，这些患者没有表现出复发性畸形。因此,没有必要通过截骨和/或跟骨延长进行后续抢救。
结论：TTS治疗有症状的扁平足，与所示的其他程序相结合，与目前更普遍接受的内侧移位截骨或跟骨延长方法相比，具有优势。1年的结果是是否需要进一步治疗的良好预测。与其他手术管理方法相比，这是一个更简单和首选的选择，根据我们的经验,消除了截骨或跟骨延长的需要。
方法：IV回顾性病例系列。
未经批准：StevensP,兰开斯特A,KhwajaA.Talar-tarsal稳定：目标和初步成果。策略创伤肢体重建2021；16(3)：168-171。
