两种跗骨融合术治疗Müller-Weiss病的比较  

Comparison of two kinds of tarsal fusion for Müller-Weiss disease

作　　者：张志[1] 张光辉[1] 徐宝强 陈磊[1] 范洪进[1] 张磊[1] 荣存敏[1] 栗威[1] ZHANG Zhi;ZHANG Guang-hui;XU Bao-qiang;CHEN Lei;FAN Hong-jin;ZHANG Lei;RONG Cun-min;LI Wei(Department of Hand and Foot Surgery,Affiliated Hospital,Jining Medical Col-lege,Jining272000,China)

机构地区：[1]济宁医学院附属医院手足外科,山东济宁272000

出　　处：《中国矫形外科杂志》2021年第17期1605-1608,共4页Orthopedic Journal of China

基　　金：山东省重点科技攻关计划项目(编号:JN15023);济南市科技局医养健康基金项目(编号:2018SMNS002)。

摘　　要：[目的]比较两种跗骨融合术治疗Müller-Weiss病的近期疗效。[方法]2015年3月-2019年8月手术治疗MüllerWeiss病患者17例(25足)。其中,16足采用距舟楔关节融合术,9足采用距舟关节融合术。比较两组临床与影像结果。[结果]距舟楔融合组的手术时间及自体髂骨植骨比率均显著大于距舟融合组(P<0.05)。末次随访时,距舟楔融合组AOFAS和VAS评分均显著优于距舟融合组(P<0.05)。影像方面,与术前相比,末次随访时两组患者Tomeno-Méary角(Tomeno-Méary angle,TMA)和跟骨倾斜角(calcaneal pitch angle,CPA)显著增加(P<0.05),而内弓角(medial longitudinal arch angle,MLAA)显著减小(P<0.05)。末次随访时,距舟楔融合组的TMA、MLAA和跟骨倾斜角(calcaneal pitch angle,CPA)均显著优于距舟融合组(P<0.05)。[结论]距舟楔关节融合治疗Müller-Weiss病Ⅲ-Ⅳ期患者,术后近期临床效果优于距舟关节融合。[Objective] To compare the short-term outcomes of two kinds of tarsal fusion for Müller-Weiss disease. [Methods] From March 2015 to August 2019, a total of 17 patients(25 feet) with Müller-Weiss disease were treated surgically. Among them, 16 feet were treated with talonavicular-cuneiform arthrodesis(the TNC group), while the remaining 9 feet were treated with talonavicular arthrodesis(the TN group). The clinical and imaging consequences were compared between the two groups. [Results] The TNC group consumed significantly longer operation time, with significantly higher ratio of autologous iliac bone grafting than the TN group(P<0.05). At the last follow-up,the TNC group proved significantly superior to the TN group in term of AOFAS and VAS scores(P<0.05). Regarding to imaging, the Tomeno-Méary angle(TMA) and calcaneal pitch angle(CAP) significantly increased(P<0.05), while the medial longitudinal arch angle(MLAA)significantly decreased(P<0.05) in both groups at the latest follow-up compared with those preoperatively(P<0.05). At the latest follow-up,the TNC group was signifcantly better than the TN group in terms of TMA, MLAA and CPA(P<0.05). [Conclusion] The talonavicular-cuneiform arthrodesis achieves better short-term clinical outcomes than the talonavicular arthrodesis for Müller-Weiss disease in stage Ⅲ-Ⅳ.

关 键 词：Muller-Weiss病 距舟关节融合 距舟楔关节融合 

分 类 号：R687[医药卫生—骨科学]