Abstract：
OBJECTIVE: Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA).
METHODS: A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01.
RESULTS: Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing.
CONCLUSIONS: SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications.
METHODS: IV.
METHODS: A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01.
RESULTS: Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing.
CONCLUSIONS: SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications.
METHODS: IV.
摘要：
目的：平面外翻足畸形（PVFD）在神经肌肉疾病儿童中很常见，严重畸形可能需要手术矫正。本研究旨在评估由距下关节置换术（SuAE）治疗的神经肌肉疾病继发PVFD的临床和放射学结果，中足软组织释放和距骨关节固定术（TNA）。
方法：回顾性分析患有神经肌肉疾病和不可减少性PVFD的儿童接受SuAE，中足软组织松解术,和TNA，并进行了至少5年的随访。对包括脑瘫在内的60例神经肌肉疾病（108英尺）患者进行了回顾。手术的平均年龄为12.7±4.6岁（6-17岁）。平均随访时间为7±2.9年（5-10）。将最终随访时的临床结果和放射学校正与术前值进行比较。进行统计学分析,显著性设定为P<0.01。
结果：对于所有角度值，发现术前和术后值之间具有统计学意义的放射学改善。在最后的后续行动中，VAS评分有显著改善(4.8vs.2；P<0.01）。步行能力的提高也有积极的趋势。在最后的随访中没有报告假性关节病的病例。108英尺中的5英尺（4.6％）和2英尺（3.3％）的内侧伤口延迟愈合，需要拔除螺钉。
结论：SuAE联合TNA和中足软组织是一种安全可行的方法，可以为神经肌肉疾病和不可减少的PVFD患者提供良好的临床和放射学结果；该方法可以改善足部稳定性，并发症数量有限。
方法：IV.
方法：回顾性分析患有神经肌肉疾病和不可减少性PVFD的儿童接受SuAE，中足软组织松解术,和TNA，并进行了至少5年的随访。对包括脑瘫在内的60例神经肌肉疾病（108英尺）患者进行了回顾。手术的平均年龄为12.7±4.6岁（6-17岁）。平均随访时间为7±2.9年（5-10）。将最终随访时的临床结果和放射学校正与术前值进行比较。进行统计学分析,显著性设定为P<0.01。
结果：对于所有角度值，发现术前和术后值之间具有统计学意义的放射学改善。在最后的后续行动中，VAS评分有显著改善(4.8vs.2；P<0.01）。步行能力的提高也有积极的趋势。在最后的随访中没有报告假性关节病的病例。108英尺中的5英尺（4.6％）和2英尺（3.3％）的内侧伤口延迟愈合，需要拔除螺钉。
结论：SuAE联合TNA和中足软组织是一种安全可行的方法，可以为神经肌肉疾病和不可减少的PVFD患者提供良好的临床和放射学结果；该方法可以改善足部稳定性，并发症数量有限。
方法：IV.
