距下关节制动术治疗儿童柔韧性扁平足的疗效评价  

Efficacies of subtalar arthrorisis in pediatric flexible flatfoot

作　　者：苏正兵[1] 杨述华[1] 段德宇[1] 梁琳琳[1] 刘冠杰[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华小儿外科杂志》2014年第8期611-614,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的：探讨距下关节制动术在治疗儿童柔韧性扁平足中的矫形效果，并对其疗效进行评价。方法回顾性分析2012年8月至2013年10月接受距下关节制动术治疗的15例柔韧性扁平足患儿的诊治结果，分别测量和分析术前、术后前后位片上距跟角、距-第一跖骨角和侧位片上距-第一跖骨角、距骨倾斜角，并用 Maryland 足部评分系统对术前、术后情况进行评价。结果14例患儿获得随访，随访时间为6~20个月。随访病例均无重要血管神经损伤等并发症发生。术后患足疼痛及足弓塌陷等症状均明显好转。前后位片上距跟角平均由术前26.6°±2.5°减小到术后20.8°±2.1°（P〈0.05），距-第一跖骨角平均由术前13.7°±1.8°减小到术后6.4°±1.3°（P 〈0.05），侧位片上距骨倾斜角平均由术前27.9°±2.4°减小到术后20.7°±2.2°（P 〈0.05），距骨-第一跖骨角平均由术前11.4°±1.3°减小到术后3.7°±1.1°（P 〈0.05）。术前、术后均采用 Maryland 足部评分系统进行评价，平均由术前（58.2±6.7）分提高到术后（86.4±5.6）分（P 〈0.05）。结论距下关节制动术是治疗儿童柔韧性扁平足的有效方法，具有简单、安全、创伤小，术后并发症少等优点，但此项技术在国内开展的时间不是太长，还需进一步观察其远期疗效。Objective To explore the efficacies of subtalar arthrorisis correction in pediatric flexible flatfoot.Methods From August 2012 to October 2013,retrospective analyses were conducted for 1 5 flexible flatfoot cases undergoing subtalar arthrorisis.We measured the talo calcaneal angles and talar-first metatarsal angles on anteroposterior films and talar-first metatarsal angles and talar decline angles on lateral films.At the same time,the Maryland Foot Score was employed to evaluate and analyze the preoperative and postoperative status.Results During a follow-up period of 6-20 months, there was no onset of vascular or nerve injuries for 14 patients.Postoperatively foot pain,arch collapse and other symptoms obviously improved.On anteroposterior films,anteroposterior distance angles declined from preoperative 26.6°±2.5°to postoperative 20.8°±2.1°（P 〈0.05）,talar-first metatarsal angles decreased from preoperative 13.7°± 1 .8° to postoperative 6.4°± 1 .3° （P 〈0.05）;on lateral films,talar angles declined from preoperative 27.9°± 2.4° to postoperative 20.7°± 2.2° （P 〈 0.05） while talar-first metatarsal angles decreased from preoperative 1 1 .4°± 1 .3° to postoperative 3.7°± 1 .1°（P 〈0.05）.Before and after surgery,the mean Maryland foot scores rose from preoperative （58.2 ±6.7）points to （86.4±5.6）points post-operation（P 〈0.05）.Conclusions As an effective treatment for flexible flatfoot,subtalar arthrorisis offers the advantages of simple operation,safety,mini-trauma, short operative duration,fewer postoperative complications and better outcomes.It is worthy of wider promotion and further development in clinic practice.

关 键 词：距下关节 扁平足 手术治疗 

分 类 号：R726.8[医药卫生—儿科]