距下关节融合术后中足功能评价  

Evaluation of midfoot function after subtalar arthrodesis

作　　者：杨崇林[1] 徐向阳[1] 李星辰[1] 刘津浩[1] 朱渊[1] 魏宝富[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,200025 [2]山东省临沂市人民医院足踝显微外科,200025

出　　处：《中华骨科杂志》2014年第4期431-435,共5页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81272051）

摘　　要：目的探讨单纯距下关节融合术后中足关节的活动度改变和退变情况。方法回顾性分析1996年1月至2011年8月行距下关节融合并获得完整随访的37例患者资料，男27例，女10例；年龄13-74岁，平均42．6岁。采用健康调查简易量表（the MOS item short form health survey，SF-36）评分和美国足踝外科学会（American Orthopaedic Foot andAn．kleSociety，AOFAS）中足评分评价疗效。摄双足负重位X线片，观察中足关节是否有退变。双足在踝关节最大跖屈和最大背伸时摄侧位x线片，从矢状面测量Meary角，比较患侧与健侧跖跗关节活动度。患者站立于内翻30。和外翻30。斜面并摄踝关节正位x线片，从冠状面测量胫骨长轴与足前跖面所夹锐角（tibio-plantarangle，TPA），比较中足的活动度改变。行足踝部SPECT／CT检查，评估中足关节退变情况。结果37例患者随访2~17年，平均9．2年。术前sF-36总分评分为（34．26±11．02）分，末次随访时为（77．59±12．57）分，两者比较有统计学差异；术前AOFAS中足评分为（86．14±16．79）分，末次随访时为（86．43±16．70）分，两者比较差异无统计学意义。矢状面，内侧跖跗关节活动度患侧约受限20％。冠状面，内翻时健侧与患侧TPA分别平均为61．32。和64．91。，患侧减小12．5％；外翻时双侧TPA分别平均为76．54。和82．28。，患侧减小约42．6％。SPECT／CT发现13例患者（35．1％，13／37）的距舟关节、21例（56．8％，21／37）的跟骰关节、10例（27．0％，10／37）的跖骰关节、5例（13．5％，5／37）的舟楔关节发生退变，但关节无明显疼痛。结论距下关节融合可导致中足的矢状面活动受限，冠状面活动代偿性增加，特别是外侧跗中和跖跗关节活动度增加，这使跗中关节更易出现轻度退变。Objective To evaluate the influence of simple subtalar arthrodesis to the motion and degeneration of midfoot. Methods Data of 37 patients （27 males, 10 females） with an average age of 42.6 years who had undergone subtalar joint fusion from January 1996 to August 2011 were retrospectively analyzed. The MOS item short form health survey （SF-36）, American Ortho- paedic Foot and Ankle Society （AOFAS） midfoot score were used. Midfoot sagittal and coronal motion were measured on ankle ra- diographs of maximum plantar flexion and dorsiflexion. On sagittal plane, the Meary angle was measured and the bilateral tarso-metatarsal joints mobility was compared. On coronal plane, tibio-plantar angles （TPA） on 30 degrees varus slope and 30 degrees valgus slope were respectively measured on the anterio-posterior ankle X-ray films to observe the changes of midfoot activities. Be- sides, single photon emission computed tomography/computed tomography （SPECT/CT） of bilateral foot and ankle was taken to es- timate the degeneration of midfoot joint. Results All the 37 patients were followed-up, with mean follow-up period of 9.2 years. The average SF-36 scores was increased from 34.26±11.02 points preoperatively to 77.59±12.57 points postoperatively. The aver-age AOFAS midfoot scores were 86.14±16.79 points preoperatively and 86.43±16.70 points postoperatively without any statistical significant difference. On sagittal plane, medial tarsometatarsal joints mobility was limited by 20%. According to coronal plane of varus slope, the average TPA of healthy side and operated side were 61.32° and 64.91°, respectively, so the varus mobility of oper-ated side was limited by 12.5%. While standing on the valgus slope, the average TPA of both sides were 76.54° and 82.28°, which indicated that valgus mobility of operated side was reduced by 42.6%. 35.1% patients of talonavicular joint, 56.8% patients of cal- caneocuboid joint, and 27.0% patients of metatarsal cuboid joint were found mild joint degeneration on SPECT/CT im

关 键 词：距下关节 关节融合术 跗关节 骨关节炎 

分 类 号：R687.3[医药卫生—骨科学]