Abstract

Introduction

Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP.

Method

Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients’ age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling’s criteria during the patient’s last follow-up visit.

Results

The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients’ median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I–III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%).

Conclusion

The modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients’ gender, age, initial GMFCS level, and CP type.

中文翻译：

---

改良后胫骨后肌腱分裂转移治疗痉挛性等位足畸形：长期疗效并与标准方法比较

摘要

介绍

胫骨后肌腱分裂术（SPOTT）是脑瘫（CP）患者后足内翻畸形的一种治疗选择。这项研究的目的是介绍由我们的资深作者开发的最新改良的SPOTT手术的长期结果，并将其与标准SPOTT技术在因CP引起的等位足畸形中进行比较。

方法

我们的回顾性队列研究包括因采用标准或改良的SPOTT技术治疗的CP而导致的痉挛性足部畸形的患者。手术时患者年龄≥5岁，至少随访4年。在患者的最后一次随访中，使用Kling的标准评估了手术结局。

结果

分析包括124例患者（146英尺），其中105英尺采用标准SPOTT技术治疗，41英尺采用改良SPOTT技术。手术时患者的中位年龄为11岁。对患者进行了为期八年的随访，在此期间，改良的SPOTT技术显示出比标准组明显更好的手术效果（38英尺（92.7％）/ 79英尺（75.2％，p）的优/好结果= 0.02）。两组患者的GMFCS水平，手术时的年龄或患者性别没有明显差异。在标准组和修改组中，CP模式的分布相似。痉挛性偏瘫是最普遍的形式，其次是痉挛性截瘫和痉挛性截瘫。总体而言，GMFCS I–III级患者的手术成功率更高（分别为100％，94.8％和69.8％）。GMFCS IV级（90.9％）患者经常注意到SPOTT手术失败。

结论

改良的SPOTT程序在长期随访中证实了因CP引起的等足性足畸形患者的有效性和安全性。与标准手术相比，新改良的SPOTT技术无论患者的性别，年龄，初始GMFCS水平和CP类型如何，均可显着改善手术效果。