一期距骨复位联合胫前肌腱移位术治疗先天性垂直距骨  

Surgical correction of congenital vertical talus by one-stage comprehensive soft-tissue release and peritalar reduction incorporating tibialis anterior transfer

作　　者：闫桂森[1] 俞志涛[1] 杨征[1] 鲁明[1] 张建立[1] 

机构地区：[1]北京积水潭医院小儿骨科, 100035

出　　处：《中华医学杂志》2014年第17期1322-1325,共4页National Medical Journal of China

摘　　要：目的 探讨先天性垂直距骨病例采用一期松解距骨周围复位联合胫前肌腱移位术的治疗方法.方法 对2006年1月至2011年12月北京积水潭医院小儿骨科先天性垂直距骨病人21例35足采用一期充分软组织松解、距骨周围复位联合胫前肌腱移位至距骨颈进行治疗.男女比例2.5∶1,23％为单纯性垂直距骨,其余均合并有其他先天性或神经肌肉源性疾患.手术年龄12～48个月,平均30.1个月.手术采用相同术式完成,定期进行临床和X线观察,采用Kodros标准评价.X线参数的比较采用t检验.结果 平均随访3.5（1.5～7）年.在全部35足中,优9％,良77％,可14％.所有患者家长均对足部外观和功能表示满意.均可穿正常鞋.结果为可的病例均合并多发关节挛缩症.未发现距骨缺血坏死,尚无病例需要再手术治疗.X线参数术后与术前相比有显著改善并获得正常（P＜0.05）,末次随访与术后相比差异无统计学意义（P＞0.05）.结论 先天性垂直距骨多数合并有其他先天性或神经肌肉源性疾患.4岁之前采用一期充分软组织松解距骨周围复位联合胫前肌腱移位治疗能够获得满意疗效.Objective To evaluate the surgical efficacies of one-stage comprehensive soft-tissue release and peritalar reduction incorporating tibialis anterior transfer （CSTR-PTR-TAT） in patients with congenital vertical talus （CVT） before the age of 4 years.Methods Thirty-five feet of 21 children with true congenital vertical talus were underwent one-stage CSTR-PTR-TAT.The male-to-female ratio was 2.5∶ 1.Twenty-three percent （5 patients with 8 feet） belonged to isolated CVT and the remaider CVT associated with other congenital or neuromuscular abnormalities.The mean operative age was 30.1 （12-48） months.All patients were available for clinical and radiological follow-ups for a mean period of 3.5 （1.5-7） years.Kodros scoring system was utilized for assessment of final outcomes.Results The outcomes of 3 feet （9%） were excellent,27 （77%） good and 5 （14%） fair.All patients wore normal shoes and were satisfied by their functional results and appearance.The patients with fair results were associated with arthrogryposis.No talar avascular necrosis was encountered.None required further operation.Radiologically there was a statistically significant postoperative improvement of measured angles compared to preoperative values （P 〈 0.05）.All radiological parameters were within normal ranges.There was no difference of posoperative angles compared to those at the final follow-up （P 〉 0.05）.Conclusion As a complex deformity usually associated with other congenital or neuromuscular abnormalities,CVT may be satisfactorily managed with one-stage correction by CSTR-PTR-TAT before the age of 4 years.

关 键 词：足畸形 距骨 腱转移术 

分 类 号：R726.8[医药卫生—儿科]