RU-2861551-C1 - METHOD FOR SURGICAL CORRECTION OF PLANOVALGUS ABDUCTION DEFORMITY OF FEET IN CHILDREN WITH CEREBRAL PALSY AT GMFCS LEVEL III-IV OF MOTOR IMPAIRMENT

Abstract

FIELD: medicine. SUBSTANCE: invention relates to paediatric surgery, traumatology and orthopaedics, and can be used for surgical correction of planovalgus abduction deformity of the feet in children with cerebral palsy at GMFCS level III-IV of motor impairment. The method includes dissection of soft tissues on the medial surface of the foot, displacement of the tibialis posterior tendon, performing capsulotomy of the talonavicular joint. The displaced talus is relocated relative to the navicular bone using instruments to form a longitudinal arch. The medial column is fixed with a Kirschner wire. An external oblique approach is made along the skin fold, 3 cm long, in the projection of the sinus tarsi and the anterior part of the calcaneus. The fascia is incised with displacement of the muscle belly of the extensor digitorum brevis. The sinus tarsi, freed from fat to the lower surface of the talar neck, is exposed. A groove is formed in the talar neck. The anterior part of the calcaneus is exposed, displacing the peroneal tendons. At a distance of 1 cm from the edge of the articular surface of the calcaneocuboid joint, a transverse osteotomy of the calcaneus is performed, preserving the medial cortex. Using instruments, the calcaneal fragments are spread apart by the width of the correction until the talar head is completely covered. An autograft taken from the fibula is introduced into the wedge-shaped diastasis. The proximal end of the autograft is inserted into the formed groove of the talar neck. The wound is sutured in layers. EFFECT: reduction of surgical trauma, correction of all components of severe foot deformity, pathological pronation, prevention of foot deformity recurrence, increasing the stability of the correction with improvement of support and gait quality by stabilising the foot by introducing an autograft from the fibula into the calcaneal diastasis and under the talar neck. 3 cl, 2 dwg, 1 ex

Inventors

• Kozhevnikov Vadim Vitalevich
• Kostomarov Artem

Dates

Publication Date

20260505

Application Date

20250930

Claims (3)

1. 1. A method for surgical correction of planovalgo-abductor foot deformity in children with cerebral palsy GMFCS level III-IV motor impairment, including dissection of soft tissues along the medial surface of the foot, displacement of the posterior tibial tendon, capsulotomy of the talonavicular joint, characterized in that the displaced talus is brought out relative to the scaphoid bone with the help of instrumentation with the formation of a longitudinal arch, the medial column is fixed with a Kirschner wire, an external oblique approach is performed along a 3 cm long skin fold in the projection of the tarsal sinus and the anterior part of the calcaneus, then the fascia is dissected with the displacement of the muscle belly of the short extensors of the fingers, the tarsal sinus is isolated, freed from the tissue to the lower surface of the neck of the talus, a groove is formed in the neck of the talus, the anterior part of the calcaneus is isolated, displacing the tendons of the peroneal muscles, Next, at a distance of 1 cm from the edge of the articular surface of the calcaneocuboid joint, a transverse osteotomy of the calcaneus is performed with preservation of the medial cortex, then, using instruments, the fragments of the calcaneus are spread to the width of the correction until the head of the talus is completely covered, an autograft taken from the fibula is introduced into the wedge-shaped diastasis, the proximal end is introduced into the formed groove of the neck of the talus, and sutures are applied to the wound in layers.
2. 2. The method according to paragraph 1, characterized in that the dissection of soft tissues along the medial surface of the foot is performed through an access 2 cm long.
3. 3. The method according to paragraph 1, characterized in that the site of the osteotomy of the calcaneus with the autograft introduced into the diastasis and immersed in the groove of the talus is fixed with a biodegradable material.

Description

The invention relates to medicine, namely to pediatric surgery, traumatology and orthopedics, and can be used to treat severe planovalgo-abductor deformity of the feet in children aged 10 years and older. One of the most severe orthopedic complications associated with conservative treatment of children with cerebral palsy (hereinafter CP) is planovalgo-abductor foot deformity (PVAD), which leads to decreased weight-bearing ability and quality of life in later life. Various methods of tendon-muscle grafting and corrective osteotomies have been proposed for the correction of this orthopedic complication in the form of PVAD. According to researchers, the rate of recurrence or partial loss of correction after surgical correction can reach 47%. Understandably, the desire to create a stable, corrected foot while correcting its deformity is essential. This creates the conditions for proper weight-bearing ability and the subsequent development of motor skills, prevents recurrence of the deformity, and prevents early osteoarthritis of the foot joints. A one-stage method of surgical correction of equino-plano-valgus foot deformity in children is known (Ryzhikov D.V., Surgical correction of equino-plano-valgus foot deformity in children with cerebral palsy: Abstract of a PhD thesis. – Novosibirsk, 2011. – 26 p.), which provides for the simultaneous elimination of all components of the deformity of the affected foot in the patient, with planned and controlled elimination of valgus deviation of the rear foot. The disadvantage of this method is its low efficiency with the preservation of residual instability in the joints of the midfoot, the progression of abduction (primarily in children with GMFCS III-IV level of motor impairment), especially in children aged 10-12 years. A method for correcting equino-plano-valgus foot deformity in children is known (Zubkov P.A., Improvement of surgical correction of equino-plano-valgus foot deformity in children with cerebral palsy, Dis. Cand. of Medicine, Moscow, 2023), based on osteoplastic reconstruction by autoarthroereisis using the fibula in combination (or in isolation, depending on the severity of the deformity) with plastic surgery of the deltoid ligament, lengthening of the peroneal muscles by notches. A disadvantage is insufficient stability, which the authors address with tendon-ligament grafting (deltoid ligament suture, corrugation of stretched ligaments, and incision). The correction technique does not include correction of abduction at the midfoot level (Chopart joint). The closest technical solution is a method for three-joint arthrodesis of the foot in patients with spastic paralysis (patent RU 2775136, IPC A61B 17/56, published June 28, 2022), characterized by eliminating the equinus component of the deformity by performing an aponeurotomy of the gastrocnemius muscle. A longitudinal incision is made along the posteromedial surface, at the junction of the middle and upper thirds of the leg. A layer-by-layer dissection of the soft tissues is performed. The aponeurotic portion of the gastrocnemius muscle is isolated and dissected. A medial incision is then made on the foot. A layer-by-layer dissection of the soft tissues is performed. The posterior tibial muscle is isolated. A capsulotomy of the talonavicular joint is performed. Corrective resection of the articular surfaces is performed, and arthrodesis is performed through two surgical approaches located on the medial and lateral surfaces of the foot. Osteosynthesis is performed antegrade and retrograde through two surgical approaches. For this, an arcuate lateral incision is made on the foot, the short extensor digitorum muscle is exposed with a U-shaped flap with the base facing anteriorly, the tendons of the brevis and longus peroneus muscles are exposed, the calcaneocuboid joint is exposed, and corrective resection of the articular surfaces is performed. Through the lateral incision, resection of the articular surfaces of the subtalar joint is performed, and osteosynthesis of the talus, navicular, cuboid, and calcaneus is performed. Osteosynthesis of the subtalar joint is performed through the medial incision. A screw is inserted in the oblique-sagittal plane. Arthrodesis of the subtalar joint is performed through a medial approach in the oblique-sagittal plane, the talonavicular joint through a medial approach in the horizontal plane, and the calcaneocuboid joint through a lateral approach in the horizontal plane. Layered wound closure is performed, restoring the insertion of the extensor digitorum brevis. However, in cases of severe valgus and abduction of the anterior midfoot, this type of intervention requires greater trauma during joint access, more extensive excision of the bony structures of the foot to achieve optimal anatomy (shape), and subsequent shortening of the foot. Insufficient correction of the pronation element of the foot deformity has also been noted. The use of this method in children aged 1