足第一跖列关节外双截骨术治疗儿童僵硬性高弓足畸形  

Extraarticular double osteotomy of the first ray for pediatric pes cavus

作　　者：伍江雁[1] 谭谦[1] 杨戈 周天生 胡欣[1] 王军[1] 莫莎莎 梅海波[1] Wu Jiangyan;Tan Qian;Yang Ge;Zhou Tiansheng;Hu Xin;Wang Jun;Mo Shasha;Mei Haibo(Department of Orthopedics,Hunan Children s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院骨科,长沙410007

出　　处：《临床小儿外科杂志》2022年第8期719-724,共6页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科建设项目-湖南省儿童医院小儿外科(湘卫医发[2022]2号)。

摘　　要：目的探讨保留关节的足第一跖列关节外双截骨和软组织松解手术,矫治以第一跖列僵硬性高弓为主的儿童高弓足畸形的临床疗效。方法回顾性分析2017年7月至2019年7月湖南省儿童医院骨科收治的儿童高弓足畸形病例资料,共11例18足,平均年龄8.5岁(6.2~12.5岁)。均采取足第一跖列关节外双截骨及软组织松解与肌力平衡术,手术要点:①第一跖骨近端背侧闭合性楔形截骨术;②内侧楔形骨跖侧截骨撑开术;③截骨术后行软组织松解和肌力平衡术。疗效评价采用Wicart高弓足评分方法。结果本组病例随访时间平均32(24~48)个月,末次随访时外形、足负重及行走功能均明显改善,无一例行走疼痛,2例2足遗留跟骨内翻需行跟骨截骨矫形术。X线测量Meary角由术前平均(34.4±8.5)°下降至(11.2±2.4)°(P<0.05),跟骨轴线由术前平均内翻-6.1°±1.3°改善至外翻4.2°±0.8°(P<0.05),Pitch角由术前平均(45.2±6.4)°下降至(22.4±5.4)°(P<0.05),Hibb角由术前平均(121.4±11.2)°增加至(145.8±10.7)°(P<0.05),差异均有统计学意义。疗效评价优13足,良3足,可2足。结论足第一跖列关节外双截骨术在高弓足畸形顶点截骨,保留了中跗关节,避免了关节融合,用于矫正位于第一跖列的儿童僵硬性高弓足,短期疗效满意,长期疗效需进一步观察。该方法适合骨骼尚未发育成熟的儿童高弓足;对于合并固定性前足内收和内翻、跟骨外翻者,需行骰骨和跟骨截骨矫形。Objective Pediatric pes cavus is a complex deformity caused mostly by flexion of the forefoot,especially on the first ray(cuneiform&metatarsal).The aim of this study was correcting rigid pes cavus deformity of the first metatarsal ray stepwise and observing clinical efficacy through joint sparing extraarticular double osteotomy and soft tissue surgery.This procedure is different from most other cross-joint osteotomies or fusions.Methods From July 2017 to July 2019,clinical data were retrospectively reviewed for 11 children with 18 feet of pes cavus.The average age was 8.5(6.2-12.5)years.After preoperative clinical and radiological evaluations,extraarticular double osteotomy of the first ray,soft tissue releasing and muscle balance were performed along with closed wedge osteotomy of proximal dorsal end of the first metatarsal bone,open medial wedge osteotomy,foot plantar incision,peroneus longus tendon transferring to peroneus brevis tendon and Achilles tendon extension.The efficacy was evaluated by Wicart grading system.Results Appearance,weight bearing and walking function of 18 feet improved markedly without pain.Osteotomy was required for calcaneal varus in two feet(n=2).The mean Meary angle declined from(34.4°±8.5°)to(11.2°±2.4°)(P<0.05),the mean calcaneal axis improved from-6.1°±1.3°to 4.2°±0.8°(P<0.05),the mean Pitch angle decreased from(45.2°±6.4°)to(22.4°±5.4°)(P<0.05)and the mean Hibb angle spiked from(121.4°±11.2°)to(145.8°±10.7°)(P<0.05).The mean follow-up period was 32(24-48)months.The outcome was excellent(13 feet),fair(3 feet)and decent(2 feet).Conclusion For pes cavus in children,extraarticular double osteotomy on the first ray while retaining joint may avoid joint fusion.The short-term efficacy is satisfactory while long-term outcomes require further observations.Cubotomy and calcaneal osteotomy are necessary for children with fixed forefoot adduction and varus and calcaneal valgus deformity.

关 键 词：弓形足/外科学 截骨术/方法 治疗结果 儿童 

分 类 号：R726.8[医药卫生—儿科]