Evans截骨联合胫后肌止点重建治疗副舟骨源性平足症的临床观察  

Clinical efficacy of Evans osteotomy combined with tibialis posterior tendon reconstruction in treatment of flatfoot with painful accessory navicular

作　　者：陈宏峰[1] 李真[1] 牛俊克 王鹏儒 栗启迪 贺喜顺[1] Chen Hongfeng;Li Zhen;Niu Junke;Wang Pengru;Li Qidi;He Xishun(Department of Orthopedics,the Second Affiliated Hospital of Luohe Medical College,Luohe 462300,China)

机构地区：[1]漯河医学高等专科学校第二附属医院足踝外科,河南漯河462300

出　　处：《足踝外科电子杂志》2020年第3期26-30,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：河南省科技攻关项目(192102310397)。

摘　　要：目的探讨Evans截骨联合胫后肌止点重建治疗痛性副舟骨继发平足症的临床疗效。方法以2013年1月至2019年1月在本院接受手术治疗的26例痛性副舟骨继发Ⅱ期平足症患者为观察对象。所有患者均采用Evans截骨联合胫后肌止点重建术治疗,术后常规行负重位X线评估足部力线,最终随访时以美国足踝外科学会(American orthopedic foot and ankle society score,AOFAS)踝-后足评分、疼痛视觉模拟评分(visual analogue scale,VAS)进行功能评定,并与术前进行对比。结果26例均获得随访,随访时间18~48个月,平均(29.53±1.69)个月;所有患者足部力线均恢复正常;AOFAS评分85~96分,平均(90.07±3.17)分,优23例,良2例,一般1例,优良率96.15%;VAS评分0~2分,平均(0.37±0.12)分;和术前相比AOFAS评分和VAS评分均有显著改善(P<0.05)。1例术后出现足部外侧疼痛,取出内固定后疼痛缓解。结论Evans截骨联合胫后肌重建治疗痛性副舟骨继发平足症,缓解疼痛明显,能有效纠正负重时足弓塌陷、前足外展及跟骨外翻,恢复正常足部力线,临床效果良好。Objective To investigate the clinical efficacy of Evans osteotomy combined with tibialis posterior tendon reconstruction in treatment of stageⅡflatfoot with painful accessory navicular.Methods 26 cases of stageⅡflatfoot with painful accessory navicular in our hospital from January 2013 to January 2019 were selected as the observation objects.All patients were treated with Evans osteotomy combined with tibialis posterioralis insertion reconstructive surgery.Postoperative X-ray was routinely used to assess foot alinement.At the final follow-up,American orthopedic foot and ankle society score(AOFAS)and visual analogue scale(VAS)for pain were used for functional evaluation and compared with preoperative results.Results All 26 cases were followed up for 18~48 months with an average of(29.53±1.69)months.The alinement of the foot of all patients were back to normal.The AOFAS score was 85~96,with an average of(90.07±3.17);the AOFAS score showed excellent in 23 cases,good in 2 cases and fair in 1 case,with an excellent and good rate of 96.15%.VAS score was 0~2,with an average of(0.37±0.12).Compared with the preoperative score,the postoperative AOFAS and VAS scores were improved significantly(P<0.05).One patient had lateral foot pain after surgery,which was relieved after removal the internal fixation.Conclusion Evans osteotomy combined with tibialis posterior tendon reconstruction can effectively relieve the pain of stageⅡflatfoot with painful accessory navicular.It can effectively correct the arch collapse,anterior foot abduction and calcaneal valgus,and restore the normal foot alinement.

关 键 词：平足症 副舟骨 Evans截骨 

分 类 号：R687.3[医药卫生—骨科学]