Samuel K Van de Velde, H Kerr Graham, Ken Ye, Henry Chambers, Erich Rutz
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Reconstructive surgery included the excision of a 2 to 3-cm segment of the tibialis anterior tendon to correct the elevation of the first metatarsal. The fixed deformity of the first metatarsophalangeal joint was managed with use of corrective arthrodesis and dorsal plate fixation. Clinical and radiographic outcomes were assessed preoperatively and postoperatively at the transition to adult services.</p><p><strong>Results: </strong>There were significant improvements in the clinical and radiographic outcome measures (p < 0.001). Pain was relieved, and there were no further episodes of skin breakdown. The elevation of the first metatarsal was corrected from a mean of 3° of dorsiflexion to a mean of 19° of plantar flexion. The deformity of the first metatarsophalangeal joint was corrected from a mean of 55° of plantar flexion to a mean of 21° of dorsiflexion. Six patients had complications, all of which were grade I or II according to the modified Clavien-Dindo system.</p><p><strong>Conclusions: </strong>The surgical reconstruction of a dorsal bunion via soft-tissue rebalancing of the first ray and corrective arthrodesis of the first metatarsophalangeal joint resulted in favorable medium-term clinical and radiographic outcomes in nonambulatory adolescents with CP.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. 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引用次数: 0
摘要
背景：背侧拇外翻可能发生在患有脑性麻痹（CP）且粗大运动功能分级系统（GMFCS）等级为 IV 级或 V 级的不行动青少年身上。目前尚未就重度 CP 患者足背拇趾外翻的生物力学和手术治疗达成共识：这项回顾性队列研究纳入了 23 名患有 CP、GMFCS IV 级或 V 级、有症状且需要手术治疗的非行动不便青少年。手术时的中位年龄为17岁，中位随访时间为56个月。重建手术包括切除一段2至3厘米长的胫骨前肌腱，以矫正第一跖骨的抬高。第一跖趾关节的固定畸形通过矫正关节固定和背板固定得到了控制。对术前和术后向成人过渡时的临床和影像学结果进行了评估：临床和影像学结果均有明显改善（P < 0.001）。疼痛得到缓解，也没有再出现皮肤破损。第一跖骨的抬高得到了矫正，从平均背屈3°增加到平均跖屈19°。第一跖趾关节的畸形从平均 55° 的跖屈矫正到平均 21° 的背屈。六名患者出现了并发症，根据修改后的克拉维恩-丁多系统，所有并发症均为I级或II级：结论：通过第一跖趾关节软组织再平衡和第一跖趾关节矫形手术重建背侧拇外翻，可为不行动的CP青少年带来良好的中期临床和影像学效果：证据级别：治疗四级。有关证据级别的完整描述，请参阅 "作者须知"。
Management of Dorsal Bunion in Nonambulatory Adolescents with Cerebral Palsy: A Retrospective Cohort Study.
Background: A dorsal bunion may occur in nonambulatory adolescents with cerebral palsy (CP) and a Gross Motor Function Classification System (GMFCS) level of IV or V. The deformity can cause pain, skin breakdown, and difficulty wearing shoes and braces. A consensus on the biomechanics and surgical management of dorsal bunions in persons with severe CP has not been established.
Methods: This retrospective cohort study included 23 nonambulatory adolescents with CP, GMFCS level IV or V, and symptomatic dorsal bunions requiring surgery. The median age at surgery was 17 years, and the median follow-up was 56 months. Reconstructive surgery included the excision of a 2 to 3-cm segment of the tibialis anterior tendon to correct the elevation of the first metatarsal. The fixed deformity of the first metatarsophalangeal joint was managed with use of corrective arthrodesis and dorsal plate fixation. Clinical and radiographic outcomes were assessed preoperatively and postoperatively at the transition to adult services.
Results: There were significant improvements in the clinical and radiographic outcome measures (p < 0.001). Pain was relieved, and there were no further episodes of skin breakdown. The elevation of the first metatarsal was corrected from a mean of 3° of dorsiflexion to a mean of 19° of plantar flexion. The deformity of the first metatarsophalangeal joint was corrected from a mean of 55° of plantar flexion to a mean of 21° of dorsiflexion. Six patients had complications, all of which were grade I or II according to the modified Clavien-Dindo system.
Conclusions: The surgical reconstruction of a dorsal bunion via soft-tissue rebalancing of the first ray and corrective arthrodesis of the first metatarsophalangeal joint resulted in favorable medium-term clinical and radiographic outcomes in nonambulatory adolescents with CP.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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