距下关节稳定术治疗儿童柔韧性平足症中远期效果评价  

Medium/long-term follow-up surgical outcomes of subtalar joint stabilization for flexible flatfoot in children

作　　者：高荣轩[1] 李承鑫[1] 范竟一[1] 刘虎[1] 李浩[1] 高景淳 Gao Rongxuan;Li Chengxin;Fan Jingyi;Liu Hu;Li Hao;Gao Jingchun(Department of Orthopaedics,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院骨科,100045

出　　处：《中华小儿外科杂志》2021年第11期1010-1014,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨距下关节稳定术(extraosseous talotarsal stabilization,EOTTS)治疗儿童柔韧性平足症的疗效。方法回顾性分析2014年1月至2015年3月间收治的11例(21足)柔韧性平足症患儿的临床资料。其中,男8例(15足),女3例(6足);年龄(9.7±1.4)岁,范围在8~12.5岁。本组患儿均应用跗骨窦螺钉行EOTTS,并随访5年以上。收集患儿手术前、后及末次随访时拍摄的负重位X线片,并测量距骨第一跖骨角(Meary角)和距骨跟骨角(TCA),收集前后位X线片测量距骨第一跖骨角(T1MT)和距骨第二跖骨角(T2MT),并进行统计学分析。使用视觉模拟评分量表(VAS)和美国足踝外科协会(AOFAS)踝-后足功能评分量表对患儿手术前、后及末次随访时足部疼痛及功能进行统计学分析。结果随访(67.4±4.8)个月,范围在60~75个月。Meary角由术前的(15.0±4.6)°降至术后的(0.7±0.5)°,末次随访时为(0.7±0.7)°;TCA由术前的(43.4±10.0)°降至术后的(30.9±2.9)°,末次随访时为(29.3±2.6)°;T1MT由术前的(15.5±3.5)°降至术后的(7.5±2.4)°,末次随访时为(6.5±2.3)°;T2MT由术前的(29.6±5.1)°降至术后的(11.6±1.2)°,末次随访时为(12.5±2.1)°;VAS量表评分由术前的(5.5±0.7)分降至术后的(1.0±0.6)分,末次随访时为(1.6±0.8)分;AOFAS量表评分由术前的(69.4±3.9)分升至术后的(91.8±3.0)分,末次随访时为(90.6±2.8)分。上述各项参数术后及末次随访时水平与术前比较,差异均有统计学意义(P<0.05);而上述各项参数术后与末次随访时水平比较,差异均无统计学意义(P>0.05)。所有患儿术后症状消失,无复发。2例(2足)术后早期出现局部疼痛,经治疗后好转,无螺钉移位或脱出。结论EOTTS可有效改善儿童柔韧性平足症外观,缓解负重及行走时的疼痛症状,中远期随访效果满意。Objective To evaluate the surgical outcomes of subtalar joint stabilization(EOTTS)for flexible flatfoot in children.Methods From January 2014 to March 2015,retrospective review was conducted for clinical data of 11 children with 21 feet of flexible flatfoot undergoing EOTTS with HyProCure devices.The follow-up period was at least 5 years.There were 8 boys(15 feet)and 3 girls(6 feet)with an average age of(9.7±1.4)(8-12.5)years.Standing anteroposterior and lateral radiographs of foot were compared preoperatively,postoperatively and at the last follow-up.The values of Meary's angle and talocalcaneal angle(TCA)in lateral views and talar-first metatarsal angle(T1MT)and talar-second metatarsal angle(T2MT)in anteroposterior views were measured.Also visual analogue scale(VAS)and American Orthopedic Foot&Ankle Society(AOFAS)score were utilized for evaluating the pain and function of foot preoperatively,postoperatively and at the last follow-up.Results During a follow-up period of(67.4±4.8)(60-75)months,Meary's angle decreased from(15.0±4.6)°at pre-operation to(0.7±0.5)°at post-operation and(0.7±0.7)°at the last follow-up;TCA dropped from(43.4±10.0)°at pre-operation to(30.9±2.9)°at post-operation and(29.3±2.6)°at the last follow-up;T1MT slipped from(15.5±3.5)°at pre-operation to(7.5±2.4)°at post-operation and(6.5±2.3)°at the last follow-up;T2MT declined from(29.6±5.1)°at pre-operation to(11.6±1.2)°at post-operation and(12.5±2.1)°at the last follow-up;VAS score dipped from(5.5±0.7)at pre-operation to(1.0±0.6)at post-operation and(1.6±0.8)at the last follow-up;AOFAS score spiked from(69.4±3.9)at pre-operation to(91.8±3.0)at post-operation and(90.6±2.8)at the last follow-up.Significant differences existed in the levels of the above-mentioned parameters at post-operation,at the last follow-up and at pre-operation(P<0.05).No significant difference existed between the above-mentioned parameters at post-operation and at the last follow-up(P>0.05).Pain in tarsal sinus(n=2,2 feet)improved after arch

关 键 词：平足症 儿童 距下关节稳定术 治疗结果 

分 类 号：R726.8[医药卫生—儿科]