BACKGROUND Analyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors. METHODS CP patients with PV deformity younger than 18 years old who had undergone more than a year of follow-up with at least two standing foot radiographs were included. Anteroposterior and lateral talo-first metatarsal(talo-1stMT), talo-second metatarsal(talo-2ndMT), and hallux valgus(HV) angles were measured on the radiographs. The rate of progression was adjusted by multiple factors using the linear mixed model, with the Gross Motor Function Classification System(GMFCS) level as the fixed effect and age and each subject as random effects. RESULTS Overall, 194 patients were enrolled in this study, and 1272 standing foot radiographs were evaluated. The AP talo-2ndMT angle progressed by 0.59° (p < 0.0001) and 0.64° (p = 0.0007) in GMFCS level II and III patients, respectively; however, there was no significant change in GMFCS level I patients (p = 0.3269). HV was significantly affected by age in all three GMFCS groups; it increased by 0.48° (p < 0.0001), 0.66° (p < 0.0001), and 1.19° (p < 0.0001) for levels I, II, and III, respectively. The lateral talo-1stMT angle showed improvements in GMFCS level I and II patients (0.43°, p < 0.0001, and 0.61°, p < 0.0001, respectively). In GMFCS level III patients, there was no significant improvement in the lateral talo-1stMT angle (p = 0.0535). CONCLUSIONS The GMFCS level was the single most important factor influencing the progression of radiographic indices in PV deformity in CP. The AP talo-1stMT and talo-2ndMT angles progressed in patients with GMFCS levels II and III. Physicians should take this result into consideration when planning the timing of the surgery. LEVEL OF EVIDENCE Prognostic Level IV.

中文翻译：

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脑性瘫痪患者的扁平血管畸形进展。

背景技术根据年龄和影响因素分析脑性瘫痪（CP）患者的扁平疱疹（PV）畸形的影像学变化。方法纳入了18岁以下的PV畸形的CP患者，他们接受了一年以上的随访，并至少拍了两张X光片。在X线片上测量前后第一侧lateral骨和外侧第一侧tar骨（talo-1stMT），第二侧tal骨（talo-2ndMT）和拇外翻（HV）角度。使用线性混合模型通过多个因素调整进展速度，其中大运动功能分类系统（GMFCS）水平作为固定效应和年龄，每个受试者作为随机效应。结果总体上，该研究招募了194例患者，并对1272例足部X线照片进行了评估。AP talo-2ndMT角前进0.59°（p​​ < GMFCS II级和III级患者分别为0.0001）和0.64°（p = 0.0007）；但是，GMFCS I级患者无明显变化（p = 0.3269）。在所有三个GMFCS组中，HV均受年龄影响。对于I，II和III级别，它分别增加了0.48°（p <0.0001），0.66°（p <0.0001）和1.19°（p <0.0001）。talo-1stMT外侧角在GMFCS I级和II级患者中均有改善（分别为0.43°，p <0.0001和0.61°，p <0.0001）。在GMFCS III级患者中，talo-1stMT外侧角无明显改善（p = 0.0535）。结论GMFCS水平是影响CP PV畸形放射学指标进展的唯一最重要因素。GMFCS II和III级患者的AP talo-1stMT和talo-2ndMT角度发展。在计划手术时机时，医师应考虑此结果。证据级别预后等级IV。