距下关节融合治疗成人伴腓骨肌痉挛的距骨前外侧副关节面撞击综合征  

Subtalar joint arthrodesis for the treatment of accessory anterolateral talar facet impingement syndrome in adults with peroneal spasm

作　　者：陶友伦[1] 卜祥博 常步青 郝云甲[1] 张述才[1] 范家强[1] 吕泽祥 张在轶 王爱国[1] Tao Youlun;Xiangbo Bu;Chang Buqing;Hao Yunjia;Zhang Shucai;Fan Jiaqiang;Lyu Zexiang;Zhang Zaiyi;Wang Aiguo(Department of Foot and Ankle Surgery,Xuzhou Central Hospital,Xuzhou Clinical School of Xuzhou Medical University,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院/徐州医科大学徐州临床学院足踝外科,徐州221009

出　　处：《中华解剖与临床杂志》2023年第2期98-103,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨距下关节融合治疗成人伴有腓骨肌痉挛的距骨前外侧副关节面(AATF)撞击综合征(AATFIS)的临床疗效。方法系列病例报告。纳入2017年3月—2021年4月徐州市中心医院足踝外科伴腓骨肌痉挛的AATFIS成年患者18例(18足),其中男10例、女8例,年龄22~56(42±11)岁。18例患者均行距下关节融合+跗骨窦清理+AATF切除术,其中7例伴腓骨短肌短缩患者同期行腓骨短肌腱延长术。术中模拟患肢负重状态,并与非负重状态交替,观察两种情况下距下关节旋转以及AATF与跟骨颈撞击情况。术后随访期间观察患者的美国足踝外科协会(AOFAS)踝-后足功能评分、疼痛视觉模拟评分法(VAS)评分以及改良Ashworth量表腓骨肌肌张力分级评估,并将末次随访观察数据与术前进行对比;同时,根据患者末次随访的AOFAS踝-后足功能评分评价临床疗效。结果18例患者均可见较大的AATF,其中软骨损伤13足、距跟前韧带损伤16足、距跟骨间韧带损伤7足,副关节面周围及跟骨颈部骨赘增生11足。患者术后恢复良好,手术切口均一期愈合。18例患者均获得随访,随访时间11~43(17.5±6.3)个月。患者术后随访期间复查影像学资料均显示距下关节融合良好,无不融合病例。术后患者痉挛解除或缓解,足弓恢复良好,后足力线良好,前中足无明显外展。末次随访时AOFAS踝-后足功能评分[(84.6±6.2)分]高于术前[(33.8±6.7)分],VAS评分[1(0,2)分]较术前[7(7,8)分]降低,改良Ashworth量表腓骨肌肌张力分级(0级9例、1级9例)较术前(3级6例、4级12例)降低,差异均有统计学意义(t=27.65、Z=3.78、Z=3.84,P值均<0.05)。根据AOFAS踝-后足功能评分评定疗效,本组患者疗效优5例、良9例、可4例。结论距下关节融合是治疗成人伴有腓骨肌痉挛的AATFIS的一种简单而有效的方法。Objective This study aims to investigate the clinical effect of subtalar joint arthrodesis in treating accessory anterolateral talar facet(AATF)impingement syndrome(AATFIS)in adults with peroneal spasms.Methods Herein,a retrospective analysis was performed on the clinical data of 18 adult patients with AATFIS with peroneal spasm treated by subtalar joint arthrodesis in the Foot and Ankle Surgery Department of Xuzhou Central Hospital from March 2017 to April 2021,including 8 females and 10 males and the age ranged from 22 to 56(42±11)year.Subtalar joint arthrodesis was performed in 18 patients,while tarsal sinus was cleared,and the accessory anterolateral talar facet was resected.In addition,peroneal brevis tendons lengthening was performed in seven patients with peroneal brevis contraction.During the operation,the weight bearing of the affected limb was simulated and alternated with the non-weight bearing.Meanwhile,the rotation of the subtalar joint and the impact of AATF on the calcaneal neck were observed under the two conditions.Moreover,the clinical effects were evaluated by the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot function scale,visual analog scale(VAS)of pain,and the modified Ashworth muscle tone scale before and at the last follow-up.Results All 18 patients had large accessory anterolateral talar facet,and 13,16,7,and 11 of which had AATF cartilage injury,anterior talocalcaneal ligaments injury,talocalcaneal interosseous ligaments injury,and osteophyte hyperplasia around the accessory articular surface and calcaneal neck,respectively.The patients recovered well post-operation,and all surgical incisions healed by first intention.Afterward,all 18 patients were followed up for 11-43(17.5±6.3)months.During the postoperative follow-up,imaging data of all patients showed good subtalar joint arthrodesis,and no nonunion cases were observed.Postoperative spasms were relieved,the arches were well recovered,the hindfeet alignments were good,and there was no obvious abduction of the midfoot.I

关 键 词：关节疾病 关节融合术 距下关节 距骨前外侧副关节面 撞击综合征 腓骨肌痉挛 

分 类 号：R687.4[医药卫生—骨科学]