疼痛性儿童平外翻的手术治疗:距下关节外螺钉关节挛缩与改良Evans重建的标准技术相比如何?

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-10-01 Epub Date: 2025-05-01 DOI:10.1097/BPO.0000000000003004
Adam Nasreddine, Alexandra Dunham, Michelle Mo, Patricia E Miller, Susan T Mahan
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引用次数: 0

摘要

背景:尽管采用了最大限度的非手术治疗方法并寻求手术治疗,但仍有一部分儿童柔性平外翻(PPV)患者会出现顽固性症状和功能障碍。本研究的主要目的是比较微创距下关节外螺钉关节内固定术(SESA)与传统改良Evans重建(MER)技术进行柔性PPV矫正的患者的临床过程和影像学改善,包括最终对准。方法:从2010年到2022年,在单一机构接受(1)SESA +/- Vulpius或副舟骨或跗骨联合切除术(22英尺)或(2)MER +/- Vulpius(23英尺)治疗的31例10至19岁的PPV患者中的45英尺进行了鉴定。术后无负重x光片的患者被排除在外。全面的术前和术后x线测量是通过站立x线片获得的。采用非劣效性分析评估各治疗组的影像学结果。使用混合效应回归模型进行临床特征比较,以解释同一患者双侧测量之间的相关性。结果:手术平均年龄13.7岁(SD, 1.9);该队列中53%为男性。SESA组和MER组在年龄、BMI和偏侧性方面没有差异。与MER相比,SESA组的手术时间明显更短(51分钟vs 167分钟;结论:与改良Evans重建术(MER)相比,距下关节外螺钉关节固定术(SESA)对于儿童性扁平足外翻(PPV)是一种侵入性更小、疗效更好的方法。我们的研究发现,与MER相比,青少年接受SESA治疗的放射学改善和畸形矫正效果相似,而且手术时间更短,负重时间更早。无重大并发症。需要长期随访和患者报告的结果研究,特别是螺钉取出后。证据等级:治疗性病例对照研究,III级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Treatment for Painful Pediatric Pes Planovalgus: How Does Subtalar Extra-articular Screw Arthroereisis Compare to the Standard Technique of Modified Evans Reconstruction?

Background: A subset of patients with flexible pediatric pes planovalgus (PPV) will have recalcitrant symptoms and functional impairment despite maximizing nonoperative methods and seeking surgical care. The primary aim of this study was to compare the clinical course and radiographic improvement including final alignment for patients who underwent the minimally invasive corrective subtalar extra-articular screw arthroereisis (SESA) technique compared with the traditional modified Evans reconstruction (MER) technique for flexible PPV correction.

Methods: Forty-five feet in 31 PPV patients aged 10 to 19 years treated at a single institution with (1) SESA +/- Vulpius or accessory navicular or tarsal coalition excision (22 feet) or (2) MER +/- Vulpius (23 feet) from 2010 to 2022 were identified. Patients with no weight-bearing postoperative x-rays were excluded. Comprehensive preoperative and postoperative radiographic measurements were obtained from standing radiographs. Radiographic outcomes were evaluated across treatment groups using noninferiority analysis. Comparisons in clinical characteristics were conducted using mixed-effects regression modeling to account for the correlation between bilateral measurements within the same patient.

Results: Surgery was performed at an average age of 13.7 years (SD, 1.9); the cohort was 53% male. There were no differences in age, BMI, or laterality between the SESA and MER cohorts. The SESA cohort had a significantly shorter operative time compared with MER (51 vs. 167 min; P <0.001). One patient in the MER cohort required a return to the operating room for hardware removal in the setting of pseudoarthrosis, and another for a buried pin. Time to weightbearing in the SESA cohort was a median 3 weeks earlier than the MER cohort ( P =0.004). The SESA procedure was found to be noninferior to MER with respect to postoperative radiographic alignment as well as in the improvement in alignment from preoperative to postoperative measurement (all P <0.05).

Conclusions: For painful pediatric pes planovalgus (PPV), subtalar extra-articular screw arthroereisis (SESA) offers a less invasive approach with noninferior outcomes compared with modified Evans reconstruction (MER). Our study found similar radiographic improvements and deformity correction in adolescents treated with SESA versus MER, along with shorter procedures and earlier weightbearing. No major complications were observed. Long-term follow-up and patient-reported outcome studies are needed, especially postscrew removal.

Level of evidence: Therapeutic case-control study, level III.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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