距舟关节融合联合跟骨截骨治疗Müller-Weiss病的早期疗效  

Short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy for Müller-Weiss disease

作　　者：屈福锋 蔡杰 梁晓军[2] 李毅[2] 鹿军 姬维娜 曾秋[2] QU Fufeng;CAI Jie;LIANG Xiaojun;LI Yi;LU Jun;JI Weina;ZENG Qiu(Xi'an Medical University,Xi'an Shaanxi,710068,P.R.China;Department of Foot and Ankle Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an Shaanxi,710054,P.R.China)

机构地区：[1]西安医学院,西安710068 [2]西安交通大学附属红会医院足踝外科,西安710054

出　　处：《中国修复重建外科杂志》2019年第2期166-169,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨距舟关节融合联合跟骨截骨治疗Müller-Weiss病的早期疗效。方法 2015年6月—2017年2月,对14例(14足)保守治疗无效的Müller-Weiss病患者行距舟关节融合联合跟骨截骨治疗。男3例,女11例;年龄35～56岁,平均46.2岁。左足6例,右足8例。Maceira分期:Ⅲ期5例,Ⅳ期9例。病程4～12年,平均7年。术前摄X线片测量Saltzman位后足力线为(9.8±2.8)°,侧位跟骨倾斜角(calcaneal pitch angle,CPA)为(14.7±5.1)°,侧位距骨第1跖骨角(Meary角)为(4.8±2.8)°,正位距骨第1跖骨角(talar 1 meta-tarsal angle,T1MA)为(25.0±7.3)°;无邻近关节骨关节炎。术前疼痛视觉模拟评分(VAS)为(5.9±1.5)分,美国矫形外科足踝协会踝与后足评分(AOFAS)为(58.8±17.6)分。结果患者均获随访,随访时间14～27个月,平均22.3个月。术后2例出现足内侧麻木感,2例切口感染;其余患者无明显不适。末次随访时,VAS评分为(1.6±1.3)分,AOFAS评分为(90.6±2.7)分,均较术前明显改善(t=8.18,P=0.00;t=–6.95,P=0.00)。X线片复查示,患者距舟关节及跟骨截骨均达骨性愈合;测量Saltzman位后足力线为(–2.5±2.7)°,侧位CPA为(25.0±5.2)°、Meary角为(2.6±2.1)°,正位T1MA为(8.1±3.8)°;除Meary角与术前比较差异无统计学意义(t=1.53,P=0.15)外,Saltzman位后足力线、CPA、T1MA与术前比较差异均有统计学意义(t=11.93,P=0.00;t=–8.89,P=0.00;t=8.05,P=0.00)。结论对于保守治疗无效且无邻近关节骨关节炎的Müller-Weiss病患者,采用距舟关节融合联合跟骨截骨治疗可获得较好的早期疗效。Objective To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease. Methods Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment, were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years(range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years(mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was(9.8±2.8)°, calcaneal pitch angle(CPA)on lateral position was(14.7±5.1)°, Meary angle on lateral position was(4.8±2.8)°, and talar 1 meta-tarsal angle(T1 MA)on anteroposterior position was(25.0±7.3)°. Preoperative visual analogue scale(VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society(AOFAS) ankle-hindfoot score was 58.8±17.6. Results All patients were followed up 14-27 months(mean, 22.3 months). Medial numbness and incision infection occurred in 2, 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showingsignificant differences when compared with preoperative ones(t=8.18, P=0.00;t=–6.95, P=0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was(–2.5±2.7)°, CPA on lateral position was(25.0±5.2) °, Meary angle on lateral position was(2.6±2.1)°, T1 MA on anteroposterior position was(8.1±3.8)°. There was no significant difference in Meary Angle between pre-and post-operation(t=1.53, P=0.15). And there were significant differences in the hindfoot axis, CPA, and T1 MA between pre-and postoperation(t=11.93, P=0.00;t=–8.89, P=0.00;t=8.05, P=0.00). Conclusio

关 键 词：Müller-Weiss病 距舟关节融合 跟骨截骨 

分 类 号：R687.3[医药卫生—骨科学]