腓骨截骨术对距下关节力线变化的影响  

Effect of proximal fibular osteotomy on subtalar joint

作　　者：郭家良[1] 董维冲 秦迪[2] 金霖[1] 董天华[1] 林哲 侯志勇[1] 张英泽[1] Guo Jialiang;Dong Weichong;Qin Di;Jin Lin;Dong Tianhua;Lin Zhe;Hou Zhiyong;Zhang Yingze(Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第三医院骨科,石家庄050000 [2]河北医科大学第三医院骨病科,石家庄050000 [3]河北医科大学第二医院药学部,石家庄050000

出　　处：《骨科临床与研究杂志》2019年第6期325-328,348,共5页Journal Of Clinical Orthopedics And Research

基　　金：河北省医学科学研究重点课题(20180451)~~

摘　　要：目的评估腓骨截骨术对距下关节力线变化的影响。方法回顾分析2015年1月至2016年8月河北医科大学第三医院骨科收治的行腓骨截骨手术的49例患者(53膝)的病历资料。通过影像学测量以及临床指标评估患者的术后恢复情况。影像学测量指标包括髋-膝-踝角(HKA)、股骨胫骨角(FTA)、胫骨倾斜角(TI)、股骨远端关节面角(TAS)、距骨倾斜角(TT)、腓骨长度(FL)以及后足力线指标。临床指标包括美国膝关节协会评分(KSS)、美国足踝外科协会(AOFAS)踝-后足评分以及视觉模拟评分(VAS)。结果49例患者(53膝)术后膝关节功能恢复良好。治疗前后KSS评分、HKA、FTA、TI、TT、后足力线角(HAVA)、后足力线比例(HAR)以及后足瞬时力臂(HMA)指标比较,差异均有统计学意义(均P>0.05);但AOFAS踝-后足评分、VAS评分及腓骨的近端移位情况比较,差异均无统计学意义(均P>0.05)。下肢机械轴的变化与距下关节的变化存在明显的相关性(P<0.01)。结论腓骨截骨不仅能改善膝关节的疼痛,同时还能纠正距下关节及踝关节的力线。Objective To evaluate the effect of proximal fibular osteotomy(PFO)on subtalar joint.Methods A total of 49 patients(53 knees)who underwent PFO in Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University from January 2015 to August 2016 were enrolled and followed-up retrospectively.The postoperative recovery of patients were evaluated radiographically and clinically.Radiographic evaluations were measured by the hip-knee-ankle angle(HKA),the femoro-tibial angle(FTA),tibial inclination(TI),distal tibial articural surface(TAS),talar tilt(TT),length of fibular(FL),and hind foot alignment(HAVA,HAR,HMA).The questionnaires of the American Knee Society Score(KSS),the ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society(AOFAS),visual analogue score(VAS)were used to assess the patients clinically.Results The function of knee joint recovered well after operation in 49 patients(53 knees).Compared with pre-treatment,there was a significant difference in KSS HKA,FTA,TI,TT,HAVA,HAR and HMA after PFO(all P<0.05),but no significant difference exhibited in AOFAS,VAS and FL in ankle joint after treatment(all P>0.05).There was an obvious correlation between the preop-postop variances in HKA and hindfoot alignment(P<0.01).Conclusion Due to the structural improvements of ankle and subtalar joint,PFO not only improves joint function but also the alignment of ankle joint radiographically.

关 键 词：截骨术 腓骨 距下关节 力学 放射测量术 骨关节炎 膝 

分 类 号：R68[医药卫生—骨科学]