关节镜下改良Brostr?m术联合微创跟骨截骨术治疗合并隐匿性高弓足的慢性踝关节外侧不稳  

Arthroscopic modified Broström procedure plus minimally invasive calcaneal osteotomy for the treatment of chronic lateral ankle instability combined with subtle cavus foot

作　　者：傅绍菱 顾文奇[2] 李学谦 陈城 王诚 宋国勋 张解元 邹剑[1] 薛剑锋[1] 苏琰[1] 梅国华[1] 施忠民[1] Fu Shaoling;Gu Wenqi;Li Xueqian;Chen Cheng;Wang Cheng;Song Guoxun;Zhang Jieyuan;Zou Jian;Xue Jianfeng;Su Yan;Mei Guohua;Shi Zhongmin(Ankle Soction,Department of Orthopedics,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China;Department of Orthopedics,Lin Gang Campus,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 201306,China)

机构地区：[1]上海交通大学附属第六人民医院骨科-足踝外科,上海200233 [2]上海交通大学附属第六人民医院临港院区骨科,上海201306

出　　处：《中华创伤杂志》2022年第8期693-700,共8页Chinese Journal of Trauma

基　　金：上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD018);科技部国家重点研发计划(2018YFC2001504);上海市人工智能创新发展专项项目(2020-RGZN-02006);上海市“科技创新行动计划”生物医药领域科技支撑项目(19441902400)。

摘　　要：目的探讨关节镜下改良Brostr?m术联合微创跟骨截骨术治疗合并隐匿性高弓足的慢性踝关节外侧不稳的短期疗效。方法采用回顾性病例系列研究分析2016年11月至2020年11月上海交通大学附属第六人民医院收治的12例合并隐匿性高弓足的慢性踝关节外侧不稳患者的临床资料, 其中男5例, 女7例;年龄16~62岁[(40.3±15.1)岁]。均采用关节镜下改良Brostr?m术联合微创跟骨截骨术治疗。比较术前、术后3个月及1年足负重侧位跟骨倾斜角、Meary角、内侧楔骨高度及后足长轴位跟骨外翻角, 评估骨性结构及足部力线改善情况;采用美国足踝外科协会(AOFAS)踝-后足评分及视觉模拟评分(VAS)评估踝关节功能及疼痛改善程度。观察术后并发症情况。结果患者均获随访1~3年[(1.6±0.6)年]。跟骨倾斜角由术前(24.6±5.3)°降至术后3个月及1年的(22.5±4.9)°、(22.3±5.0)°;Meary角由术前6.6°(5.2°, 7.6°)降至术后3个月及1年的2.5°(0.5°, 3.8°)、2.1°(0.5°, 3.2°);内侧楔骨高度由术前(24.3±5.3)mm降至术后3个月及1年的(22.3±4.8)mm、(22.3±4.6)mm;跟骨外翻角由术前-7.1°(-10.3°, -5.9°)增至术后3个月及1年的2.3°(-2.5°, 4.5°)、2.4°(-1.6°, 3.8°)(P均<0.01)。与术后3个月比较, 术后1年跟骨倾斜角、Meary角、内侧楔骨高度及跟骨外翻角差异无统计学意义(P均>0.05)。AOFAS踝-后足评分由术前(66.8±8.7)分增至术后3个月及1年的(81.0±5.9)分、(88.6±3.6)分(P均<0.01), 术后1年时优4例, 良8例, 优良率为100%。VAS由术前2.5(2.0, 4.0)分降至术后3个月及1年的2.0(1.3, 2.8)分、1.0(0.0, 2.0)分(P均<0.01)。与术后3个月比较, 术后1年AOFAS踝-后足评分、VAS差异有统计学意义(P均<0.05)。1例患者术后出现伤口愈合不良, 后经换药后愈合。患者均无血管、神经损伤等并发症。术后1年随访期间未见畸形及关节不稳复发。结论对于合并隐匿性高弓足的慢性踝关节外侧不稳, �Objective To evaluate the short-term outcome of arthroscopic modified Broström procedure plus minimally invasive calcaneal osteotomy for the treatment of chronic lateral ankle instability combined with subtle cavus foot.Methods A retrospective cohort study was conducted to analyze the clinical data of 12 patients suffering chronic lateral ankle instability combined with subtle cavus foot admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from November 2016 to November 2020,including 5 males and 7 females,aged 16-62 years[(40.3±15.1)years].All patients were treated with arthroscopic modified Broström procedure plus minimally invasive calcaneal osteotomy.The calcaneal pitch angle,Meary′s angle and medial cuneiform height on the foot weight-bearing lateral view plus calcaneus valgus angle on the hindfoot long axial view were compared to evaluate the improvement of bony structure and foot alignment preoperatively and at 3 months and 1 year postoperatively.At the same time,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS)were used to evaluate the improvement of ankle function and pain.Postoperative complications were also observed and recorded.Results All patients were followed up for 1-3 years[(1.6±0.6)years].The calcaneal pitch angle was decreased from(24.6±5.3)°preoperatively to(22.5±4.9)°at postoperative 3 months and(22.3±5.0)°at postoperative 1 year;the Meary′s angle was decreased from 6.6°(5.2°,7.6°)preoperatively to 2.5°(0.5°,3.8°)at postoperative 3 months and 2.1°(0.5°,3.2°)at postoperative 1 year;the medial cuneiform height was decreased from(24.3±5.3)mm preoperatively to(22.3±4.8)mm at postoperative 3 months and(22.3±4.6)mm at postoperative 1 year;the calcaneus valgus angle was increased from-7.1°(-10.3°,-5.9°)preoperatively to 2.3°(-2.5°,4.5°)at postoperative 3 months and 2.4°(-1.6°,3.8°)at postoperative 1 year(all P<0.01).However,there were no significant differences in the calcanea

关 键 词：关节不稳定性 足畸形 截骨术 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]