距下关节制动联合软组织手术治疗大龄儿童柔性平足症  

Treatment for adolescent flexible flatfoot with subtalar arthroereisis and soft tissue procedures

作　　者：李兵[1] 俞光荣[1] 杨云峰[1] 于涛[1] 赵有光[1] 周海超[1] 朱辉[1] Li Bing;Yu Guangrong;Yang Yunfeng;Yu Tao;Zhao Youguang;Zhou Haichao;Zhu Hui(Department of Orthopedics,Affiliated Tongji Hospital,Tongji University School of Medicine,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中华小儿外科杂志》2020年第4期356-360,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(81501931、31800782)。

摘　　要：目的 探讨距下关节制动联合软组织手术治疗青少年柔性平足症的手术疗效。方法 2015年1月至2017年1月,通过距下关节制动联合跟腱或腓肠肌松解及足内侧软组织紧缩术治疗青少年柔性平足症患儿20例,22侧足。其中男13例,15侧足,女7例,7侧足。2例男性患儿为双侧柔性平足症。患儿年龄8~12岁,平均9.5岁。采用AOFAS评分、VAS评分和患足负重位X线摄片对手术前后情况进行评价。结果 18例患儿20侧足获得随访18~36个月,平均25.3个月。伤口均Ⅰ期愈合,无感染。术后足部疼痛,足弓塌陷等症状较前明显缓解。末次随访时Meary角由术前的(17.5°±4.4°)改善为术后(4.1°±1.2°)(P<0.05),X线正位片第一跖距角由术前的(15.3°±3.1°)改善为术后(4.8°±1.3°)(P<0.05),AOFAS踝-后足评分由术前的(66.6±5.8)分改善为术后(88.6±7.9)分(P<0.05),VAS评分由术前的(6.6±0.6)分改善为术后(1.7±0.3)分(P<0.05)。结论 距下关节制动联合软组织手术能更好的矫正畸形,恢复力线,是治疗青少年柔性平足症简单而有效的方法,可获得较高的临床满意度。Objective To explore the therapeutic outcomes of subtalar arthroereisis plus Achilles tendon or gastrocnemius recession and medial soft tissue tightening for adolescent flexible flatfoot.Methods Twenty patients(22 feet)with pediatric flexible flatfoot were treated from January 2015 to January 2017.There were 13 boys(15 feet)and 7 girls(7 feet)with an average age of 9.5(8-12)years.The scores of American Orthopedic Foot&Ankle Society Score(AOFAS)and visual analogue scale(VAS)plus angles were measured for evaluating preoperative and postoperative status.Results A total of 18 patients(20 feet)were followed up for an average period of 25.3(18-36)months.All wounds healed primarily without infection.Postoperative foot pain,arch collapse and other symptoms obviously improved.At the last follow-up,Meary angle decreased from 17.5°±4.4°to 4.1°±1.2°(P<0.05)and talar-first metatarsal angle dropped from 15.3°±3.1°to 4.8°±1.3°(P<0.05).The mean AOFAS scores increased from 66.6±5.8 to 88.6±7.9(P<0.05)while the mean VAS scores decreased from 6.6±0.6 to 1.7±0.3(P<0.05).Conclusions Subtalar arthroereisis and soft tissue procedures can effectively correct adolescent flexible flatfoot.As a simple measure,it obtains favorable clinical outcomes and patient satisfaction.

关 键 词：距下关节 关节制动术 平足症 治疗 

分 类 号：R726.8[医药卫生—儿科]