足副舟骨疼痛综合征继发ⅡA期胫后肌肌腱功能不全的手术治疗  

Operative treatment for symptomatic accessory navicular bone and stage ⅡA posterior tibial tendon dysfunction

作　　者：祝文刚[1] 王水勋[1] 牛洪华[1] 邱俊涛[1] 于春旭[1] 易芳林[1] 张小刚[1] 

机构地区：[1]解放军第159医院显微外科,河南省驻马店市463000

出　　处：《中国矫形外科杂志》2012年第5期406-410,共5页Orthopedic Journal of China

摘　　要：[目的]探讨足副舟骨疼痛综合征继发ⅡA期胫后肌肌腱功能不全的手术治疗。[方法]2005年10月～2010年2月,对16例足副舟骨疼痛综合征继发ⅡA期胫后肌肌腱功能不全的患者施行副舟骨切除+趾(母)长屈肌腱转移术。男5例,女11例;年龄15～27岁,平均23.5岁。右足7例,左足9例。Ⅰ型副舟骨4例,Ⅱ型副舟骨9例,Ⅲ型副舟骨3例,发病至手术时间为6～24个月,平均8.5个月。所有患者均根据美国足踝外科协会(americanorthopodics foot and ankle society,AOFAS)的足与踝关节评分法进行术前、术后相关评估。[结果]术后16例获随访12～66个月,平均28.6个月。手术前后负重位X线片测量相关特异性指标,手术前后比较差异均有统计学意义(P<0.01)。其中侧位距跟角平均减少9.6°,前后位距跟角平均减少8.8°,侧位第1跖距角平均减少11.9°,跟骨倾斜角平均增加7.4°,距舟覆盖角平均减少5.4°。AOFAS(ankle-hindfoot scale)评分:总评术前为(48.26±2.08)分,术后为(84.56±1.86)分。其中疼痛指数:术前为12.57±2.06,术后为37.50±2.48;足踝关节功能指数:术前为23.32±2.81,术后为38.60±1.69;踝-后足对线指数:术前为4.60±0.6,术后为7.40±1.06。手术前后比较差异有统计学意义(P<0.01)。特别是在缓解足和踝部疲劳感、疼痛及正常穿鞋方面改善明显。[结论]足副舟骨疼痛综合征继发ⅡA期胫后肌肌腱功能不全的患者施行副舟骨切除+趾(母)长屈肌腱转移术,短期效果良好,但远期疗效有待于临床进一步观察。[Objective]To discuss the methods of the operative treatment for symptomatic accessory navicular bone and stage ⅡA posterior tibial tendon dysfunction（PTTD）.[Methods]From October 2005 to February 2010,16 patients（5 males,11 females;age 15~27 years,average 23.5 years） with symptomatic accessory navicular bone and stage ⅡA PTTD were treated by the accessory navicular bone with simple excision and flexor digitorum longus（FDL） tendon transfer.Nine cases were left side and 7 cases were right side.The cases of accessory navicular bone in stageⅠ,stageⅡand stage Ⅲ were 4,9 and 3.The averaged time from dignosis to operation were 8.5 months（range,6~24 months）.All patients were assessed before and after operation according to the hindfoot scores system（American Orthopedics Foot and Ankle Society,AOFAS）.[Results]The average follow up time of all the 16 patients were 28.6 months（range,12-66 months）.The specific index of X-ray improved significantly（P 0.01） which the lateral talocalcaneal angle decreased by 9.6°,the AP talocalcaneal angle decreased by 8.8°,the lateral talar-1st metatarsal angle decreased by 11.9°,the calcaneal inclination angle increased by 7.4°and the talonavicular coverage angle decreased by 5.4°.The AOFAS scores before operation were 48.26°±2.08° and after operation was 84.56°±1.86°.The pain indexes before operation were 12.57±2.06 and after operation were 37.50±2.48.The functional indexes of the foot and ankle joint ranged before operation were 23.32±2.81 and after operation were 38.60±1.69.The longitudinal line of the Ankle-Hindfoot indexes before operation was 4.60±0.6 and after operation was 7.40±1.06.All the data between before and after operation were significantly different by statistical analysis（P0.01）.And the benefits were obviously in releasing the fatigue of foot and ankle,alleviating the pain and wearing normal shoes.[Conclusion]With the accessory navicular bone excision and FDL tendon transfer treatment,the short-time follow-up effect

关 键 词：足副舟骨 疼痛 胫后肌腱 功能不良 外科手术 

分 类 号：R687.3[医药卫生—骨科学]