距舟-舟楔关节融合术治疗Muller-Weiss病的疗效分析  

Therapeutic effect of talus-navicular wedge arthrodesis in the treatment of Muller-Weiss disease

作　　者：李飞[1] 王成伟[1] 王雪[1] 李璐兵[1] 帕尔哈提[1] 郑辉[1] LI Fei;WANG Chengwei;WANG Xue;LI LuBing;Palhati;ZHENG Hui(Rtment of orthopedic surgery,the six affiliated Hospital,School of Medicine,Xinjiang University,Urumqi 830002,China)

机构地区：[1]新疆医科大学第六附属医院骨科

出　　处：《足踝外科电子杂志》2019年第2期11-14,共4页Electronic Journal of Foot and Ankle Surgery

基　　金：国家自然科学基金地区项目（8186030127）

摘　　要：目的探讨距舟-舟楔关节融合术治疗Ⅲ-Ⅳ期Muller-Weiss病的疗效。方法选取本院行距舟-舟楔关节融合术治疗Muller-Weiss病患者10例。术中用足踝微型钛板固定距舟、舟楔关节,全螺纹无头空心钉固定距舟关节,术中根据情况植同种异体骨结合自体髂骨重建内侧柱。比较术前术后AOFAS评分、Meary角和跟骨倾斜角。结果10例患者均获得随访,随访时间16.0~21.5个月,平均20个月。随访期间影像学检查显示距下关节与术前相比无明显退变。所有患足均获得骨性愈合,愈合时间11~19周,平均14周。1例出现切口感染,对症治疗后痊愈;4例自我感觉在不平坦路面行走时中足不适。末次随访时美国足踝外科协会(American Orthopaedic Foot&Ankle Society,AOFAS)踝与后足评分、Meary角、跟骨倾斜角较术前明显改善,差异有统计学意义(P<0.05)。结论距舟-舟楔融合术可有效缓解Muller-Weiss病引起的中后足症状,纠正平足畸形和后足内翻畸形,尤其适用于距舟关节病变合并舟楔关节病变的患者,但同时也牺牲了中后足的部分活动度,影响了行走时中足的推动作用。Objective To investigate the therapeutic effect of talus-navicular wedge arthrodesis in the treatment of Muller-Weiss disease of stageⅢand stageⅣ.Methods 10 patients with Muller-Weiss disease were treated with talus-navicular wedge arthrodesis.The talus-scaphoid and scaphoid wedge joints were fixed with mini-titanium plate of ankle and foot,and the talus-scaphoid joints were fixed with hollow screw without head.The medial column was reconstructed with allograft bone and iliac bone.AOFAS score,Meary angle and calcaneal tilt angle were compared before and after operation.Results All 10 patients were followed up for an average of 20 months,ranging from 16.0 months to 21.5 months.During the follow-up period,imaging examination showed no significant degeneration of the subtalar and navicular wedge joints compared with that before operation.Bone healing was achieved in all affected feet,the healing time ranged from 11 to 19 weeks,with an average of 14 weeks.One case had incision infection and recovered after symptomatic treatment.Four cases felt inadequate when walking on uneven road.At the last follow-up,AOFAS score,meary angle and calcaneal tilt angle were significantly improved(P<0.05).Conclusion The talus-navicular wedge fusion can effectively alleviate the symptoms of midfoot and hind foot caused by Muller-Weiss disease,correct flat foot deformity and hind foot varus deformity,especially for patients with positive signs of MaceiraⅢandⅣin the calcaneocuboid joint,but it also sacrifices part of the mobility of midfoot and hind foot,which affects the promotion of midfoot in walking.

关 键 词：足舟骨 骨坏死 距舟关节 舟楔关节 关节融合术 

分 类 号：R687.3[医药卫生—骨科学]