三关节截骨矫形融合治疗成人僵硬性高弓足效果分析  

Therapeutic effects of three-joint osteotomy combined with orthopedic fusion in treatment of rigid high arch feet in adults

作　　者：罗子璇[1] 孙亚宁 武泽皓 李彦森[1] 王晓猛[1] 唐钰超 何天博 张奉琪[1] LUO Zixuan;SUN Yaning;WU Zehao(The Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China;不详)

机构地区：[1]河北医科大学第三医院,石家庄市050051 [2]河北省儿童医院 [3]河北省老年病医院 [4]河北医科大学第四医院

出　　处：《河北医药》2021年第14期2185-2188,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20190629)。

摘　　要：目的探讨三关节截骨矫形融合术治疗成人僵硬性高弓足的临床效果。方法回顾性分析2018年1月至2020年1月应用三关节融合(距下关节、跟骰关节、距舟关节)治疗10例成人僵硬性高弓足患者;患者行三关节融合术的同时联合跟腱Z行延长及跖筋膜松解作为辅助术式改善足部功能,同时保证术后踝关节的功能位,采用美国足踝外科协会(AOFAS)踝-后足评分、视觉模拟疼痛评分(VAS)及患者术前术后的主观满意度,末次随访时通过影像学分析对比跟骨倾斜角(Pitch角)、距骨第一跖骨角(Meary角)等。结果术后10例患者全部获得随访,随访时间为15~36个月,平均23.4个月,患者均未出现手术切口感染,且术后患者的外观、症状、步态等方面均有明显的提高,末次随访时满意度评价:非常满意7例,满意2例,一般1例,不满意0例。术后AOFAS评分高于术前,VAS评分低于术前,Meary角、Pitch角及第一跖楔关节高度较术前明显改善,差异有统计学意义(P<0.05)。结论三关节截骨矫形融合治疗成人僵硬性高弓足可以显著纠正关节畸形,解除足部疼痛,提高患者的生活质量,但三关节融合术主要应用后足僵硬型高弓足,因其限制了足部部分功能,故应严格把握手术适应证。Objective To investigate the therapeutic effects of three-joint osteotomy combined with orthopedic fusion in treatment of rigid high arch feet in adults.Methods The clinical data about 10 adult patients with rigid high arch feet who were treated by three-joint fusion(subtalar joint,calcanecubic joint,and talar navicular joint)in our hospital from January 2018 to January 2020 were retrospectively analyzed.The patients underwent tri-joint fusion combined with Achilles tendon Z lengthening and plantar fascia release as an auxiliary operation to improve the foot function.The American Society of Foot and Ankle Surgery(AOFAS)Ankle-Hindfoot Score,Visual Analog Pain Score(VAS),and the subjective satisfaction degree of patients before and after surgery,and the inclination angle of the calcaneus(Pitch angle)as well as thefirst metatarsal angle of the talus(Meary angle)were observed and analyzed.Results The 10 patients were followed up after the operation,with follow-up time being 15~36 months(average 23.4 months).No surgical wound infection found in all the patients,and the appearance,symptoms,gait and other aspects of the patients after operation were significantly improved.In the aspect of satisfaction evaluation at the last follow-up:7 cases were very satisfied,2 cases were satisfied,1 case was fair,and 0 case was dissatisfied.The preoperative AOFAS score were significantly higher than those before surgery,however,the VAS scores were significantly lower than those before surgery,moreover,the Meary angle,Pitch angle and the height of the first metatarsal wedge joint were significantly improved after surgery(P<0.05).Conclusion Three-joint osteotomy and orthopedic fusion can significantly correct joint deformities,relieve foot pain,and improve the the life quality of patients.However,three-joint fusion is mainly used in hindfoot rigid high-arch feet,because of its limitations of the feet function,it is necessary to strictly control the surgical indications.

关 键 词：三关节融合术 僵硬性 高弓足 

分 类 号：R682.16[医药卫生—骨科学]