内侧柱稳定手术治疗副舟骨源性平足症的疗效分析  

Clinical Efficacy of Strengthening the Medial Column in the Treatment of Flatfoot Related with Accessory Navicular

作　　者：王欣文 刘诚 马强[1] 李毅[1] 赵宏谋[1] 鹿军 梁晓军[1] 王军虎[1] WANG Xin-wen;LIU Cheng;MA Qiang;LI Yi;ZHAO Hong-mou;LU Jun;LIANG Xiaojun;WANG Jun-hu(Department of Foot and Ankle Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,Shaanxi,China)

机构地区：[1]西安交通大学附属红会医院足踝外科,陕西西安710054

出　　处：《中国现代手术学杂志》2022年第5期376-380,共5页Chinese Journal of Modern Operative Surgery

基　　金：陕西省社会发展项目(2020SF-097)。

摘　　要：目的探讨中足内侧柱稳定手术治疗副舟骨源性平足症的临床疗效,并总结弹簧韧带修复的具体方法。方法回顾性分析我科自2017年6月至2019年12月收治的副舟骨源性平足症患者32例(46足)的临床资料。所有患者均行中足内侧柱稳定手术,主要包括弹簧韧带修复、胫后肌腱止点重建和内侧楔骨Cotton截骨。术前及术后随访时对患者进行临床评估和影像学评估,同时记录并发症的发生情况。临床评估采用AOFAS评分和VAS,以评价足部功能及疼痛情况;影像学评估采用足部的负重X线正侧位片和后足力线位片,主要测量Meary's角、Pitch角、TCA、T2MA及CVA等指标,以比较手术前后的变化。结果所有患者围手术期均无感染及神经损伤等并发症发生,术后足部外观明显改善;所有患者均获得良好随访,平均随访24.3(23~26)个月,末次随访时,患者足部疼痛得到缓解,平足畸形明显改善;AOFAS评分、VAS及Meary's角、Pitch角、TCA、T2MA、CVA等与术前比较,差异均有统计学意义(P<0.05)。结论中足内侧柱的稳定,可以有效维持内侧足弓,矫正副舟骨源性平足症的平足畸形,术后足部功能恢复良好,症状缓解显著,并发症少,在临床工作中值得推广。Objective To evaluate the clinical efficacy of strengthening the medial column in the treatment of flatfoot related with accessory navicular and to explore the details of spring ligament repair.Methods Thirty-two patients(forty-six feet)with flatfoot related with accessory navicular were analyzed retrospectively in our department from June 2017 to December 2019.All patients underwent the medial column reinforcement of middle foot.The main surgical methods included spring ligament repair,posterior tibial tendon reconstruction and medial cuneiform Cotton osteotomy.The efficacy were evaluated by clinical and imaging evaluation preoperatively and postoperatively in follow-up,and the occurrence of complications was recorded at the same time.AOFAS score and VAS was used to evaluate foot function and pain in clinical evaluation respectively.The imaging evaluation was performed by the weight-bearing X-ray of the foot.Meary's angle,Pitch angle,TCA,T2MA and CVA was measured to compare the changes before and after operation.Results All patients had no complications such as infection or nerve injury.The appearance of foot was significantly improved after surgery.They were followed up for an average of 24.3 months(23 to 26 months).The foot pain was relieved and the flatfoot deformity was significantly improved.At the last follow-up,the AOFAS score,VAS,Meary's angle,Pitch angle,TCA,T2MA and CVA were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05).Conclusion The strengthening of the medial column can effectively maintain the medial arch and correct the flatfoot deformity related with accessory navicular.The recovery of foot function is good,the symptoms are relieved significantly with few complications,so it is worth popularizing in clinical.

关 键 词：副舟骨 平足症 柔韧性 胫后肌腱 弹簧韧带 内侧楔骨 内侧柱 

分 类 号：R687.3[医药卫生—骨科学]