手术治疗跟距骨桥疗效观察  

SURGICAL TREATMENT OF TALOCALCANEAL COALITION

作　　者：俞光荣[1] 李春光[1] 李兵[1] 杨云峰[1] 李海丰[1] 周家钤[1] 袁锋[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中国修复重建外科杂志》2012年第5期522-526,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81071471)~~

摘　　要：目的探讨跟距骨桥的手术治疗方法及疗效。方法 2008年7月-2010年10月,手术治疗跟距骨桥患者10例。男4例,女6例;年龄16～70岁,平均53.5岁。先天性骨桥2例,继发性骨桥8例。跟距中间关节面骨桥3例,后关节面骨桥7例。术前患者疼痛视觉模拟评分(VAS)为(9.0±0.4)分;根据美国矫形足踝协会(AOFAS)后足评分标准为(42.4±1.4)分。合并距下关节退变2例。8例单纯跟距骨桥患者行骨桥切除并脂肪组织植入,2例合并距下关节退变患者行骨桥切除联合距下关节融合术。结果术后切口均Ⅰ期愈合。8例获随访,随访时间12～36个月,平均18个月。末次随访时VAS评分为(2.0±0.7)分,与术前比较差异有统计学意义(t=6.425,P=0.000)。AOFAS后足评分为(86.9±2.3)分,与术前比较差异有统计学意义(t=7.634,P=0.000)。单纯骨桥切除者末次随访时X线片检查示无骨桥复发及关节退变发生,关节融合者X线片示达骨性融合。结论跟距骨桥根据不同发生部位和合并症,分别采用单纯骨桥切除或联合距下关节融合术可取得较好疗效。Objective To explore the operative method and effectiveness oftalocalcaneal coalition. Methods Between July 2008 and October 2010, 10 patients with talocalcaneal coalition were treated, including 2 cases of congenital talocalcaneal coalition and 8 cases of secondary talocalcaneal coalition. There were 4 males and 6 females, aged 53.5 years on average （range, 16-70 years）. Three patients had middle-facet talocalcaneal coalition and 7 had posterior-facet talocalcaneal coalition. The preoperative visual analogue score （VAS） was 9.0 _± 0.4. According to American Orthopedic Foot and Ankle Society （AOFAS） hindfoot scale, the score was 42.4 ± 1.4. Two cases complicated by subtalar degeneration. Resection of the bone bar and fat packing were performed in 8 cases of simple talocalcaneal coalition, and resection and subtalar arthrodesis in 2 cases of talocalcaneal coalition combined with subtalar degeneration. Results Primary healing of incisions was obtained in all patients. Eight patients were followed up 18 months on average （range, 12-36 months）. At last follow-up, VAS was 2.0 ± 0.7, showing siginificant difference when compared with preoperative score （t=6.425, P=0.000）. AOFAS score was 86.9 ± 2.3, showing significant difference when compared with preoperative score （t=7.634, P=0.000）. The X-ray films showed that no recurrence of talocalcaneal coalition was observed in patients underdoing simple removal of bone bar, and bone fusion was observed in patients undergoing arthrodesis. Conclusion To achieve satisfactory outcomes for talocalcaneal coalition, a reasonable surgical procedure should be chosen according to the specific facet and complication.

关 键 词：跟距骨桥 单纯切除 关节融合 

分 类 号：R687.3[医药卫生—骨科学]