Abstract：
BACKGROUND: Congenital Vertical Talus (CVT) is a rare form of congenital rigid flatfoot. Numerous surgical techniques have been developed over the years in an attempt to definitively correct this deformity. We performed a systematic review and meta-analysis of the existing literature to compare the outcomes of children with CVT treated with different methods.
METHODS: A detailed systematic search was conducted in accordance with PRISMA guidelines. Radiographic recurrence of the deformity, reoperation rate, ankle arc of motion, and clinical scoring was compared between the following 5 methods: Two-Stage Coleman-Stelling Technique, Direct Medial Approach, Single-Stage Dorsal (Seimon) Approach, Cincinnati Incision, and Dobbs Method. Meta-analyses of proportions were performed, and data were pooled through a random effects model using the DerSimonian and Laird approach. Heterogeneity was assessed using I^2 statistics. The authors used a modified version of the Adelaar scoring system to assess clinical outcomes. An alpha of 0.05 was used for all statistical analysis.
RESULTS: Thirty-one studies (580 feet) met the inclusion criteria. The reported incidence of radiographic recurrence of talonavicular subluxation was 19.3%, with 7.8% requiring reoperation. Radiographic recurrence of the deformity was highest in the children treated with the direct medial approach (29.3%) and lowest in the Single-Stage Dorsal Approach cohort (11%) ( P <0.05). The reoperation rate was significantly lower in the Single-Stage Dorsal Approach cohort (2%) compared with all other methods ( P <0.05). There was no significant difference in the reoperation rates between the other methods. The highest clinical score was seen in the Dobbs Method cohort (8.36), followed by the group treated with the Single-Stage Dorsal Approach (7.81). The Dobbs Method resulted in the largest ankle arc of motion.
CONCLUSIONS: We found the lowest radiographic recurrence and reoperation rates in the Single-Stage Dorsal Approach cohort, while the highest rate of radiographic recurrence was seen in those treated with the Direct Medial Approach. The Dobbs Method results in higher clinical scores and ankle arc of motion. Future long-term studies focusing on patient-reported outcomes are needed.
METHODS: Level III.
METHODS: A detailed systematic search was conducted in accordance with PRISMA guidelines. Radiographic recurrence of the deformity, reoperation rate, ankle arc of motion, and clinical scoring was compared between the following 5 methods: Two-Stage Coleman-Stelling Technique, Direct Medial Approach, Single-Stage Dorsal (Seimon) Approach, Cincinnati Incision, and Dobbs Method. Meta-analyses of proportions were performed, and data were pooled through a random effects model using the DerSimonian and Laird approach. Heterogeneity was assessed using I^2 statistics. The authors used a modified version of the Adelaar scoring system to assess clinical outcomes. An alpha of 0.05 was used for all statistical analysis.
RESULTS: Thirty-one studies (580 feet) met the inclusion criteria. The reported incidence of radiographic recurrence of talonavicular subluxation was 19.3%, with 7.8% requiring reoperation. Radiographic recurrence of the deformity was highest in the children treated with the direct medial approach (29.3%) and lowest in the Single-Stage Dorsal Approach cohort (11%) ( P <0.05). The reoperation rate was significantly lower in the Single-Stage Dorsal Approach cohort (2%) compared with all other methods ( P <0.05). There was no significant difference in the reoperation rates between the other methods. The highest clinical score was seen in the Dobbs Method cohort (8.36), followed by the group treated with the Single-Stage Dorsal Approach (7.81). The Dobbs Method resulted in the largest ankle arc of motion.
CONCLUSIONS: We found the lowest radiographic recurrence and reoperation rates in the Single-Stage Dorsal Approach cohort, while the highest rate of radiographic recurrence was seen in those treated with the Direct Medial Approach. The Dobbs Method results in higher clinical scores and ankle arc of motion. Future long-term studies focusing on patient-reported outcomes are needed.
METHODS: Level III.
摘要：
背景：先天性垂直距骨（CVT）是一种罕见的先天性刚性平足。多年来，已经开发了许多外科技术，以试图最终纠正这种畸形。我们对现有文献进行了系统回顾和荟萃分析，以比较采用不同方法治疗的CVT儿童的结局。
方法：按照PRISMA指南进行了详细的系统检索。畸形的影像学复发，再手术率,脚踝的运动弧，并比较了以下5种方法的临床评分：两阶段Coleman-Stelling技术，直接中期方法，单级背侧(Seimon)进近,辛辛那提切口,和Dobbs方法。进行了比例的荟萃分析，和数据通过使用DerSimonian和Laird方法的随机效应模型进行汇总。异质性使用I^2统计数据进行评估。作者使用Adelaar评分系统的改进版本来评估临床结果。0.05的α用于所有统计分析。
结果：31项研究（580英尺）符合纳入标准。据报道，距骨关节半脱位的影像学复发发生率为19.3%，7.8%需要再次手术。在直接内侧入路治疗的儿童中，畸形的影像学复发率最高（29.3％），在单阶段背侧入路队列中最低（11％）（P<0.05）。与所有其他方法相比，单阶段背侧入路队列的再手术率显着降低（2％）（P<0.05）。其他方法的再手术率无明显差异。在Dobbs方法队列中观察到最高的临床评分（8.36），其次是单阶段背侧方法治疗组（7.81）。Dobbs方法产生了最大的踝关节运动弧。
结论：我们发现单阶段背侧入路队列的影像学复发率和再手术率最低，而在直接内侧入路治疗的患者中，影像学复发率最高。Dobbs方法导致更高的临床评分和踝关节运动弧。未来需要针对患者报告结果的长期研究。
方法：三级。
方法：按照PRISMA指南进行了详细的系统检索。
结果：31项研究（580英尺）符合纳入标准。
结论：我们发现单阶段背侧入路队列的影像学复发率和再手术率最低，
方法：三级。
