BACKGROUND A dorsal bunion may occur in nonambulatory adolescents with cerebral palsy (CP) and a Gross Motor Function Classification System (GMFCS) level of IV or V. The deformity can cause pain, skin breakdown, and difficulty wearing shoes and braces. A consensus on the biomechanics and surgical management of dorsal bunions in persons with severe CP has not been established. METHODS This retrospective cohort study included 23 nonambulatory adolescents with CP, GMFCS level IV or V, and symptomatic dorsal bunions requiring surgery. The median age at surgery was 17 years, and the median follow-up was 56 months. Reconstructive surgery included the excision of a 2 to 3-cm segment of the tibialis anterior tendon to correct the elevation of the first metatarsal. The fixed deformity of the first metatarsophalangeal joint was managed with use of corrective arthrodesis and dorsal plate fixation. Clinical and radiographic outcomes were assessed preoperatively and postoperatively at the transition to adult services. RESULTS There were significant improvements in the clinical and radiographic outcome measures (p < 0.001). Pain was relieved, and there were no further episodes of skin breakdown. The elevation of the first metatarsal was corrected from a mean of 3° of dorsiflexion to a mean of 19° of plantar flexion. The deformity of the first metatarsophalangeal joint was corrected from a mean of 55° of plantar flexion to a mean of 21° of dorsiflexion. Six patients had complications, all of which were grade I or II according to the modified Clavien-Dindo system. CONCLUSIONS The surgical reconstruction of a dorsal bunion via soft-tissue rebalancing of the first ray and corrective arthrodesis of the first metatarsophalangeal joint resulted in favorable medium-term clinical and radiographic outcomes in nonambulatory adolescents with CP. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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脑瘫非卧床青少年背侧拇囊炎的管理：一项回顾性队列研究。


背景 背侧拇囊炎可能发生在患有脑瘫 （CP） 且粗大运动功能分类系统 （GMFCS） 水平为 IV 或 V 的非卧床青少年中。畸形会导致疼痛、皮肤破损以及难以穿鞋和牙套。关于严重 CP 患者背侧拇囊炎的生物力学和手术治疗的共识尚未建立。方法 这项回顾性队列研究包括 23 名患有 CP、GMFCS IV 或 V 级以及需要手术的症状性背侧拇囊炎的非卧床青少年。手术时的中位年龄为 17 岁，中位随访时间为 56 个月。重建手术包括切除 2 至 3 cm 的胫骨前肌腱段，以矫正第一跖骨的抬高。第一跖趾关节的固定畸形通过使用矫正关节融合术和背板固定进行治疗。在过渡到成人服务时，在术前和术后评估临床和影像学结局。结果 临床和影像学结局指标有显著改善 （p < 0.001）。疼痛得到缓解，皮肤破裂不再发作。第一跖骨的抬高从背屈的平均 3° 校正为跖屈的平均 19°。第一跖趾关节的畸形从平均 55° 的跖屈矫正为平均 21° 的背屈。6 例患者出现并发症，根据改良的 Clavien-Dindo 系统，所有并发症均为 I 级或 II 级。 结论 通过第一条鳍条的软组织再平衡和第一跖趾关节的矫正关节融合术对背侧拇囊炎进行手术重建，在患有 CP 的非卧床青少年中取得了良好的中期临床和影像学结果。证据级别 治疗级别 IV 。有关证据级别的完整描述，请参阅作者说明。