背景:进行性塌陷性足畸形(PCFD)是一种进行性后足和中足畸形,引起疼痛和残疾。尽管手术治疗取决于阶段,很少有研究对患者报告和影像学结局进行了分级,并按主要阶段和修订阶段II,III,和静脉重建手术。我们的目标是使用患者报告的结果测量信息系统(PROMIS)评估手术改善情况,并确定放射学参数改善是否与患者报告的结果相关。
方法:在2013年11月至2019年1月期间,对46例接受PCFD重建的连续患者进行了PROMIS身体功能(PF)和疼痛干扰(PI)评分。36名患者完成了术前和术后的PROMIS调查,6名患者仅完成术前PROMIS调查,4例患者完成了术后12个月的PROMIS调查,但未完成术前PROMIS调查.最小随访时间为12(平均,23个月。X线校正是通过术前和术后负重X线照片测量的,并与PROMIS评分相关。测量包括距骨未覆盖角,距骨未覆盖百分比,前后距骨-第一跖骨角,米里角,内侧楔形文字高度(MCH),和内侧楔形文字-第五跖骨高度。
结果:对于整个队列,PROMISPF从37.5±5.6显著增加到42.3±7.1(P=.0014)。PROMISPI从64.5±6.0显著提高到55.1±9.8(P<0.0001)。术前,术后,PCFD分期之间的PROMIS评分变化无统计学差异。初次手术(-12.3)与翻修手术(-3.7)的PROMISPI变化明显更大(P=0.0157)。原发性手术(+6.0)与翻修手术(+2.3)相比,PROMISPF的变化更大,但未达到统计学意义。所有射线照相测量值均显著改善(P<.05)。在初级第二阶段PCFD中,术后PROMIS评分与术后MCH相关(PF:r=0.7725,P=.0020;PI:r=-0.5692,P=.0446)。
结论:PCFD重建后患者报告和影像学结果显著改善。我们发现术前没有显着差异,术后,或PCFD阶段之间的PROMIS分数变化。然而,III期患者的PROMISPF改善较小,我们认为这可能是关节固定术后功能变化的次要因素。与翻修手术相比,主要手术具有更好的患者报告结果。在初级第二阶段PCFD中,重建内侧足弓高度与疼痛和功能的改善显着相关。
方法:二级,前瞻性队列研究。
BACKGROUND: Progressive collapsing foot deformity (PCFD) is a progressive hindfoot and midfoot deformity causing pain and disability. Although operative treatment is stage dependent, few studies have looked at patient-reported and radiographic outcomes stratified by primary vs revision stage II, III, and IV reconstruction surgery. Our goal was to assess operative improvement using Patient-Reported Outcomes Measurement Information System (PROMIS) and to determine whether radiographic parameter improvement correlates with patient-reported outcomes.
METHODS: PROMIS Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent PCFD reconstruction between November 2013 and January 2019. Thirty-six patients completed pre- and postoperative PROMIS surveys, 6 patients completed only preoperative PROMIS surveys, and 4 patients completed 12-month postoperative PROMIS surveys but did not complete preoperative PROMIS surveys. Minimum follow-up was 12 (average, 23) months. Radiographic correction was measured with pre- and postoperative weightbearing radiographs and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percentage, anteroposterior talo-first metatarsal angle, Meary angle, medial cuneiform height (MCH), and medial cuneiform-fifth metatarsal height.
RESULTS: For the overall cohort, PROMIS PF increased significantly from 37.5±5.6 to 42.3±7.1 (P = .0014). PROMIS PI improved significantly from 64.5±6.0 to 55.1±9.8 (P < .0001). Preoperative, postoperative, and change in PROMIS scores were not statistically different between PCFD stages. Change in PROMIS PI was significantly greater in primary (-12.3) vs revision (-3.7) surgery (P = .0157). Change in PROMIS PF was greater in primary (+6.0) vs revision surgery (+2.3) but did not reach statistical significance. All radiographic measurements improved significantly (P < .05). In primary stage II PCFD, postoperative PROMIS scores correlated with postoperative MCH (PF: r = 0.7725, P = .0020; PI: r = -0.5692, P = .0446).
CONCLUSIONS: Patient-reported and radiographic outcomes improved significantly after PCFD reconstruction. We found no significant difference in preoperative, postoperative, or change in PROMIS scores between PCFD stages. However, stage III patients had smaller improvements in PROMIS PF, which we feel may be secondary to change in function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II PCFD, reconstructing the medial arch height correlated significantly with improvement in pain and functionality.
METHODS: Level II, prospective cohort study.