| Abstract | CILJ ISTRŽIVANJA:
Utvrditi učinkovitost inovativnog BoneStar® implantata u liječenju gibljivog spuštenog stopala III. stupnja u dječjoj dobi usporedbom rezultata artrorise učinjene spongioznim AO vijkom postavljenim anterogradno u talus te rezultate usporediti s djecom istog stupnja bolesti liječenom konzervativnom metodom.
ISPITANICI I METODE:
Od 1997. do 2009. g. navedenim je metodama bilo operirano 218 djece. Uključujući su kriteriji, osim bolnosti stopala nakon dužeg opterećenja, bili: dob od 8 do 13 godina, otisak stopala ≥ III. stupnja po Tachdjianu, Meary kut ≤ 170°, calcaneal pitch ≤ 15°, lat. talonavikularni ≤ 90°, valgus pete ≥ 5°. Isključena su starija i mlađa djeca, djeca s neurološkom bolešću i rigidna stopala s tarzalnim koalicijama.
Da bih eliminirao utjecaj krivulje učenja operativnog zahvata na rezultate, usporedio sam prvih 48 djece (96 stopala) operiranih BoneStar®om i prvih 48 djece (96 stopala) AO vijkom koja su ispunila navedene kriterije. Pri obradi je liječenje bilo završeno u obje skupine, odnosno vijci su bili izvađeni. Prosječno sam ih pratio 5 godina, i nalaze uspoređivao s nalazima 25 djece (50 stopala) koja su odbila op. zahvat i liječena ulošcima i vježbama.
Usporedio sam preoperativne i postoperativne Meary, lateralne talokalkanearne, talonavikularne, calcaneal pitch kutove, podizanje navikularne kosti od poda, plantogram pri punom opterećenju i usporedio rezultate AOFAS-Midfoot scale upitnika kod svakog djeteta.
REZULTATI:
U svim mjerenim kutovima, podizanju navikularne kosti od poda te popravljanju plantograma i valgusa pete, BoneStar® implantat je postizao bolje rezultate od AO vijka.
Kod operiranih AO vijcima Midfood scale popravio se u prosjeku sa 59,08 na 88,45 bodova (max. 95), loše pozicioniranje vijaka sam imao u 15 slučajeva, prijelom kod 11 vijaka, prijevremeno razlabavljenje u 1 slučaju, poteškoće pri vađenju kod 15 vijaka zbog zaraštanja glave u tkivo kalkaneusa.
U grupi s BoneStar® implantatom imao sam poboljšanje Midfoot scale u prosjeku sa 51 na 92,89 boda, loše pozicioniranih vijaka imao sam tri, u dva slučaja je kalkaneus obrastao glavu implantata te je stoga proksimalni dio bio razlabavljen, niti jedan implantat tijekom ugradbe nije ispao niti se slomio.
Kod djece koja su indiciranu operaciju odbila i odabrala nošenje uložaka, nisam postigao
značajno poboljšanje ni nakon navršene 14,5 godina starosti, Midfoot scale je porastao samo sa 61,25 na 64 boda.
ZAKLJUČCI:
Inovativni BoneStar® implantat kao minimalno invazivna metoda pokazao se u mjerenim parametrima učinkovitiji od AO vijka, precizniji u postavljanju, skratio je potrebiti operativni rez i znatno smanjio broj komplikacija.
Djeca smanjenih sposobnosti zbog bolnih elastično spuštenih svodova stopala trećeg stupnja po Tachdjianu nošenjem uložaka ne mogu postići značajne rezultate. |
| Abstract (english) | AIM:
It is to determine the efficiency of the innovative BoneStar® implant in treatment of flexible flatfoot grade III in childhood, comparing results of arthroresis with the AO screw, and the patients of the same grade of illness treated with conservative methods.
MATERIALS AND METHODS:
From 1997 to 2009, I operated on 218 children. Except for painful foot after long weight-bearing, the including criteria was: activity limitation, age 8-13, foot print ≥ III grade Tachdijan, Meary angle ≤ 170°, calcaneal pitch ≤ 15°, lat.talovanicular angle ≤ 90°, heel valgus ≥ 5°. Excluded were children younger than 8 years of age and older than 13 years of age, children with neurological illness and children with rigid feet with tarsal coalitions.
To eliminate the influence of the learning curve of the operative procedure on the results, I compared first 48 children (96 feet) operated with BoneStar® implant with first 48 children (96 feet) operated with the AO screw, who fullfilled given criteria. I also compared these results with findings of 25 children (50 feet) who refused the surgery, and who were treated with shoe inserts and exercises.
When the treatment was completed, all the screws were removed. The mean follow-up was over five years.
I compared preoperative and post-operative Meary, lateral talocalcaneal, talonavicular and calcaneal pitch angles, elevation of the navicular bone from the floor, standing footprint, improvement of the heel valgus position, as well as the AOFAS Midfoot scale in every child.
RESULTS:
In measured angles - Meary, lateral.talocalcaneal, talonavicular and calcaneal pitch, lifting of the navicular bone from the floor, correction of standing foot-print and valgus of the heel, BoneStar® implant achieved better results than the AO screw.
In patients operated with the AO screw, Midfoot scale was improved from 59.08 to 88.45 points (max 95). I found 15 badly positioned screws, 11 breakages, 1 temporary loosened screw, and I had difficulties in removing 15 screws because the calcaneus grew over the head of the screw.
Midfoot scale was improved from 51 to 92.89 points in children operated with BoneStar® implant. I found 3 badly positioned screws and no screw breakages. In only 2 cases the calcaneus grew over the head of the screw, therefore the proximal part was loosened. None of the screws fell out or broke while they were implanted.
Children indicated for surgery, but refused it and chose the shoe inserts and physical therapy, showed no significant improvement, not even after they reached 14.5 years of age. In this group Midfoot scale was improved only from 61.25 to 64 points.
CONCLUSION:
The innovative BoneStar® implant, as minimally invasive method, showed in measured parameters that it is more efficient than the AO screw in calcaneo stop method in childhood. The placement of the implant is more precise, there are fewer complications, and a small skin incision. Children with limited activities due to painful flexible flatfoot grade III cannot achieve significant improvement with the shoe inserts. |
