距下关节稳定术联合Kidner手术治疗青少年柔韧性平足合并痛性副舟骨的疗效观察  

Subtalar joint stabilization combined with Kidner operation in the treatment of adolescent flexible flatfoot combined with painful parascaphoid

作　　者：马富强[1] 王翔宇[1] 王爱国[1] 徐俊峰[1] 贾光辉[1] 尚林[1] 孙士强[1] 李琦[1] 张小龙 王亚磊[1] Ma Fuqiang;Wang Xiangyu;Wang Aiguo;Xu Junfeng;Jia Guanghui;Shang Lin;Sun Shiqiang;Li Qi;Zhang Xiaolong;Wang Yalei(Department of Foot and Ankle Surgery,Orthopedics Hospital of Zhengzhou City,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院足踝外科,河南郑州450052

出　　处：《足踝外科电子杂志》2020年第2期5-8,I0001,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：河南省医学科技攻关计划联合共建项目(编号:2018020711)。

摘　　要：目的探讨距下关节稳定术联合Kidner手术治疗青少年柔韧性平足合并痛性副舟骨的疗效。方法回顾性分析2017年10月—2019年1月郑州市骨科医院收治的29例(38足)柔韧性平足合并痛性副舟骨患者,其中男17例(23足),女12例(15足);年龄11~15岁,平均(13.4±1.3)岁,均采用距下关节稳定器、切除副舟骨、胫后肌腱止点重建术来治疗。记录治疗前后距舟覆盖角、距骨-第一跖骨角、距骨-第二跖骨角、Meary角、跟骨倾斜角,视觉模拟评分法(visual analogue scale,VAS)及美国足踝外科协会(American orthopedic foot and ankle society,AOFAS)踝-后足评分情况,观察并发症情况。结果所有患者均获得随访,随访时间12~26个月,平均(18.6±3.4)个月;术后有3例患足出现行走不适感,术后2~3个月逐渐消失;1例HyProcure螺钉脱出,进行翻修手术治疗。末次随访时距舟覆盖角、Meary角、距骨-第一跖骨角及距骨-第二跖骨角、VAS、AOFAS评分与术前比较,差异有统计学意义(P<0.05);跟骨倾斜角与治疗前比较,差异无统计学意义。结论采用距下关节稳定器联合副舟骨切除、胫后肌腱止点重建来治疗青少年柔韧性平足合并痛性副舟骨,能明显改善足部外观、矫正足弓塌陷、缓解足部疼痛,可获得较好的短期临床效果,并且其操作简单、术中并发症少,值得推广应用。Objective To explore the clinical effect of stabilization of subtalar joint,resection of parascaphoid and reconstruction of tendon insertion for adolescent flexible flatfoot combined with painful parascaphoid.Methods From October 2017 to January 2019,29 patients(38 feet)with flexible flat foot and painful parascaphoid were analyzed retrospectively,including 17 males(23 feet)and 12 females(15 feet),aged 11~15 years,with an average of(13.4±1.3)years old.All patients were treated with subtalar joint stabilizer,parascaphoid removal and posterior tibial tendon insertion reconstruction.Before and after treatment,the angle of talus first metatarsal,talus second metatarsal,Meary angle,vas and AOFAS scores of calcaneus inclination angle were recorded,and the complications were observed.Results All patients were followed up for 12~26 months,with an average of(18.6±3.4)months.There were 3 patients with foot walking discomfort after operation,which gradually disappeared within 2~3 months after operation.One case of HyProcure screw prolapse was treated by revision operation.At the last follow-up,the scores of the angle of coverage,Meary angle,the angle of talus first metatarsal and the angle of talus second metatarsal,vas and AOFAS were significantly improved(P<0.05),but there was no significant difference between the angle of heel inclination before and after treatment.Conclusion The use of subtalar joint stabilizer combined with scaphoid resection and posterior tibial tendon insertion reconstruction can significantly improve the appearance of feet,correct arch collapse,relieve foot pain,and obtain better short-term clinical effect,and the operation is simple,with fewer complications,which is worth popularizing.

关 键 词：距下关节稳定术 青少年 扁平足 副舟骨 

分 类 号：R68[医药卫生—骨科学]