背景:严重的成人获得性扁平足畸形(AAFD)通常与在naviculocuneiform(NC)关节的内侧柱塌陷疼痛有关。然而,许多外科医生通过手术矫正畸形,而没有直接解决这个关节。这项研究的目的是研究第一骨(TMT)融合结合距骨下融合在NC关节矫正畸形中的作用。
方法:我们回顾性分析了40例患者(41英尺),这些患者在扁平足重建手术中接受了首次TMT和距下(ST)融合。我们在术前和术后至少6个月评估了6个影像学参数,包括距骨(TN)覆盖角,外侧距骨第一跖骨角,外侧距骨角度,跟骨螺距,后脚力矩臂,和新定义的舟骨-楔形文字不一致角(NCIA)。患者报告的结果测量信息系统(PROMIS)的临床结果在术前和至少1年的随访中进行评估。
结果:NCIA展示了出色的观察者间可靠性,术前和术后测量之间没有显著变化。所有其他射线照相参数,除了跟骨音高,术后改善有统计学意义(P<0.01)。总的来说,患者在所有PROMIS域均有统计学上的显着改善(P<.01),除了抑郁症。NC畸形恶化与患者报告的预后恶化无关。
结论:我们的数据表明,在治疗AAFD患者的内侧弓疼痛性塌陷时,第一TMT关节融合结合其他手术可获得可接受的影像学和临床结果.短期随访时,我们的患者队列中NC关节畸形没有变化,患者在多个PROMIS域中获得了显着改善。尽管TMT融合对NC畸形没有影响,残留或恶化的NC畸形对临床结局无显著影响.此外,在存在距骨和/或首次TMT融合的情况下,NCIA是评估NC畸形的可靠影像学参数.
方法:三级,回顾性比较研究。
BACKGROUND: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. However, many surgeons surgically correct the deformity without directly addressing this joint. The purpose of this study was to examine the role of first-tarsometatarsal (TMT) fusion combined with subtalar fusion in correcting deformity at the NC joint.
METHODS: We retrospectively analyzed 40 patients (41 feet) who underwent first-TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed 6 radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1-year follow-up.
RESULTS: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively (P < .01). Overall, patients had statistically significant improvement in all PROMIS domains (P < .01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes.
CONCLUSIONS: Our data suggest that when addressing painful collapse of the medial arch in patients with AAFD, fusion of the first-TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint in our patient cohort at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Although TMT fusion had no effect on NC deformity, residual or worsening NC deformity did not significantly affect clinical outcomes. In addition, the NCIA was found to be a reliable radiographic parameter to assess NC deformity in the presence of talonavicular and/or first-TMT fusion.
METHODS: Level III, retrospective comparative study.