婴幼儿先天性垂直距骨与斜形距骨的诊治  

Diagnosis and treatment for congenital vertical talus and oblique talus in infants

作　　者：张菁[1] 沈品泉[1] 陈珽[1] 杨璇[1] 蔡奇勋[1] 

机构地区：[1]上海第二医科大学附属新华医院小儿骨科,200092

出　　处：《中华小儿外科杂志》2005年第3期141-144,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨先天性垂直距骨(congenital vertical talus,CVT)和斜形距骨(oblique talus,OT)的诊断与鉴别诊断以及矫形手段.方法以足侧位片测得距骨轴-第一跖骨基底部夹角(TAM-BA),跟骨轴-第一跖骨基底部夹角(CAMBA),跟距间夹角为诊断依据和评判标准,6例10足诊断为CVT,给予了Ⅰ期软组织松解手术.手术平均年龄16.5个月,随访平均时间24个月.另6例10足诊断为OT,给予系列石膏矫形.平均年龄11.3个月.结果CVT组10足有良好外观和足弓,距下关节和踝关节无明显功能障碍,X线显示无距骨缺血性坏死.平均TAMBA:术前66°(50°～98°),术后2.3°(-13°～16°);平均CAMBA:术前26.1°(14°～60°),术后-4.51°(-25°～8°);平均跟距角:术前51.8°(42°～67°),术后28.2°(23°～35°).8足效果为优,2足为良好.OT组10足的平均TAMBA由48.7°(27°～76°)改善至13.7°(-2°～33°).平均CAMBA由12.2°(-11°～48°)改善至-8.6°(-25°～14°).平均跟距角由48.7°(32°～65°)变化为36.5°(22°～59°).1足仍为舟状骨半脱位(TAMBA33°).结论足部最大跖屈位TAMBA值是鉴定僵硬性CVT与松弛性OT最为确切的指标.绝大多数OT畸形经保守治疗即可复位.而手术复位几乎是治疗CVT的唯一方法,早期软组织松解术是婴幼儿患者的最佳选择.Objective To investigate the diagnosis and treatment of congenital vertical talus (CVT) and oblique talus (OT) in infants. Methods As the standard of diagnosis and evaluation, talocalcaneal angle, the talar and the calcaneal axis-first metatarsal base angles(TAMBA and CAMBA) were recorded from lateral radiographic views of the foot. Six cases (10 feet) of CVT were treated with a single-stage soft tissue procedure. The mean age at surgery was 16.5 months and the mean follow-up term was 24 months. The other six cases (10 feet) of OT were corrected with serial casting. The mean age at correction was 11.3 months.Results Good appearance of feet and normal foot arch were obtained in ten feet with CVT. There was no avascular necrosis of the talus or restricted range of motion of the ankle and subtalar joint. TAMBA in CVT group was reduced from 66°(50°～98°)before operation to 2.3°(-13°~16°) after operation, CAMBA decreased from 26.1°(14°～60°) before operation to -4.51°(-25°~8°) after operation, and talocalcaneal angle changed from 51.8°(42°～ 67°) before operation to 28.2°(23°~35°) after operation. Ten feet with OT got good improvement in which TAMBA reduced from 48.7° (27°~76 °) before operation to 13.7° (-2°~33°) after operation, CAMBA varied from 12.2°(-11°~48°)before operation to -8.6°(-25°~14°) after operation, and talocalcaneal angle varied from 48.7 °(32°～65°) before operation to 36.5°(22°～59°) after operation. There was one subluxated talonavicular joint(TAMBA33 °).Conclusions TAMBA deserves the best index to differentiate rigid CVT and flexible OT. Conservative treatment might be applied to OT while open reduction should be carried out as promptly as possible in CVT.

关 键 词：诊断 先天性垂直距骨 术前 术后 TAM 基底部 跖骨 夹角 显示 

分 类 号：R726.8[医药卫生—儿科]