跟骨截骨联合改良Kidner手术治疗副舟骨源性平足症  

Calcaneal Osteotomy Combined with Modified Kidner Surgery In Treatment of Flat foot with Accessory Navicular

作　　者：蔡杰 屈福锋 徐军奎 李毅[2] 曾秋[2] 姬维娜 梁晓军[2] CaiJie;Qu Fufeng;Xu Junkui(Xi＇an Medical University,Xi＇an 710068,China;Foot and Ankle Surgery Department,Affiliated Red Cross Hospital,Xi＇an JiaoTong University,Xi＇an 710054,China)

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

出　　处：《实用骨科杂志》2018年第11期991-994,共4页Journal of Practical Orthopaedics

摘　　要：目的通过临床及影像学的结果评估跟骨内移截骨术结合改良Kidner手术治疗副舟骨源性平足症的临床疗效。方法自2014年1月至2015年12月,我科收治19例(25足)经6个月以上保守治疗无效的副舟骨源性平足症患者,其中男7例9足,女12例16足;年龄18～52岁,平均(33.2±9.8)岁。患者均为柔韧性平足,伴有不同程度的平足及跟骨外翻畸形,术中切除副舟骨行胫后肌腱止点带线锚钉重建术。术前及末次随访患足采用Maryland功能评分及VAS疼痛评分评定。术前及随访拍摄足负重正侧位X线片并记录负重侧位X线片跟骨倾斜角(Pitch)、跟距角(Kite)及距骨第1跖骨角(Meary's);负重正位X线片的距舟覆盖角(TCA)、距骨第1跖骨角(T1M1)的改变。结果术后19例(25足)患者均获随访,随访时间14～36个月,平均随访时间(23.6±7.1)个月。末次随访时患足Maryland功能评分为(92.1±2.1)分,VAS疼痛评分为(0.7±0.9)分,较术前比较差异均有统计学意义(P<0.01)。术后负重侧位X线片跟骨倾斜角(Pitch)、跟距角(Kite)及距骨第1跖骨角(Meary's),负重正位X线片的距舟覆盖角(TCA)、距骨第1跖骨角(T1M1)与术前比较,差异均有统计学意义(P<0.01)。术后患者切口均为Ⅰ期愈合,无内固定相关并发症发生,患者末次随防足部疼痛均消失,平足畸形明显改善。结论采用跟骨内移截骨术结合改良Kidner手术治疗副舟骨源性平足症可有效纠正平足畸形,术后患足功能恢复好,并发症少。Objective To evaluate the clinical effect of calcaneal displacement osteotomy combined with modified Kidner operation for treatment of flatfoot related with accessory navicular by clinical and imaging findings. Methods From January 2014 to December 2015,our department treated 19 cases （25 feet）flatfoot related with accessory navicular.There were 7 males （9 feet）,12 females （16 feet）;aged 18 to 52 years with an average age of （33.2±9.8） years.All patients underwent conservative treatment more than 6 months,All the patients were flexible flat foot,with varying degrees of flat feet and calcaneal valgus.The posterior tibial tendon was preformed and reconstructed with a wire anchor.The preoperative and final follow-up were evaluated by the Maryland function score and the VAS pain score.Before and after the operation,the patients underwent weight-bearing anteroposterior and lateral X-ray of foot and recorded the change of calcaneus inclination angle （Pitch）,talocalcaneal angle （Kite） and talar first metatarsal （Meary ＇ s） angle in lateral X-ray offoot,the Talonavicular coverage angle （TCA） and the talar first metatarsal angle （T1M1） of the weight-bearing anteroposterior x-ray. Results All the patients were followed up.The follow-up time of 14-36 months,the average follow-up time was （23.6±7.1） months.At the final follow-up patients Maryland score was （92.1±2.1） points,VAS pain score was （0.7±0.9）,compared with preoperative were statistically significant （ P 〈0.01）.Postoperative weight-bearing lateral radiographs of calcaneus inclination angle,talocalcaneal angle and talar first metatarsal angle,weight-bearing anteroposterior radiograph of the talonavicular coverage angle,talus first metatarsal angle werecompared with those preoperative.The differences were statistically significant （ P 〈0.01）.All incisions were healed without internal fixation related complications.At the final follow-up,the pain of the foot disappeared,and the deformity was significa

关 键 词：副舟骨源性平足症 跟骨内移截骨术 足部畸形 改良Kidner手术 

分 类 号：R682.16[医药卫生—骨科学]