距下关节稳定器治疗儿童柔韧性平足症的临床研究  

Clinical study of subtalar joint stabilizer in the treatment of flexible flatfoot in children

作　　者：张奉琪[1] 张宇 王欣[1] 王晓猛[1] 李彦森[1] 罗子旋 Zhang Fengqi;Zhang Yu;Wang Xin;Wang Xiaomeng;Li Yansen;Luo Zixuan(Department of Foot and Ankle Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Orthopedics,Xingtai General Hospital,North China Medical and Health Group,Xingtai 054000,China)

机构地区：[1]河北医科大学第三医院足踝外科,河北石家庄050000 [2]华北医疗健康集团邢台总医院骨科,河北邢台054000

出　　处：《足踝外科电子杂志》2022年第4期1-6,共6页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的 探讨距下关节稳定器治疗儿童柔韧性平足症的手术疗效。方法 回顾性分析2018年6月至2020年8月在河北医科大学第三医院足踝外科采用距下关节稳定器治疗的28例(40足)柔韧性平足症患者的资料,其中男16例(24足),女12例(16足),所有患者经保守治疗无效,故选择行距下关节制动手术治疗。术前和术后末次随访时,通过美国足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)踝-后足评分来评价踝关节功能恢复情况;采用视觉模拟评分法(visual analogue scale,VAS)评分对患者术后的主观本体感觉进行评估;比较治疗前后距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨第1跖骨角(talar 1 metatarsal angle,T1MT)、距骨第2跖骨角(talar 2 metatarsal angle,T2MT);观察随访期间的手术并发症情况。结果 28例患者(40足)均获随访12~18个月,平均15.2个月。术后切口均一期愈合,无软组织并发症。4足出现跗骨窦区域疼痛,2足给予局部封闭及冲击波治疗后好转;2足经更换较小型号的螺钉后,跗骨窦区域疼痛消失;其余患者拆除支具后逐渐开始使用矫形鞋垫负重行走,无不适主诉。末次随访时的VAS评分、AOFAS踝-后足功能评分和影像学相关指标较术前显著改善,差异有统计学意义(P <0.01)。结论 应用距下关节稳定器治疗儿童柔韧性平足症,操作简单,创伤小,安全可靠,疗效显著。Objective To investigate the surgical efficacy of subtalar joint stabilizer in the treatment of children with flexible flat foot.Methods The data of 28 patients(40 feet)with flexible flatfoot treated with subtalar joint stabilizer in Department of Podiatric Surgery,the Third Hospital of Hebei Medical University from June 2018 to August 2020 were retrospectively analyzed.There were 16 males(24 feet)and 12 females(16 feet).All patients failed to respond to conservative treatment,so they chose to undergo controlled operation with line spacing.The preoperative and postoperative American Orthopedic Foot Ankle Society ankle and hindfoot scores were compared to evaluate the recovery of ankle function;The subjective proprioception of the patients after surgery was evaluated by visual analogue scale;The first metatarsal angle(Meary angle),calcaneal Pitch angle,talonavicular coverage angle(TCA),talar 1 metatarsal angle(T1MT),and talar 2 metatarsal angle(T2MT)were compared before and after treatment;Surgical complications during follow-up was observed.Results All 28 patients(40 feet)were followed up for 12~18 months,with an average of 15.2 months.All incisions healed in one stage without soft tissue complications.Four feet had tarsal sinus pain,and two feet were cured after local sealing and shock wave treatment.The pain in the sinus tarsi area disappeared after the replacement of smaller screws in 2 feet,and the other patients gradually began to walk with the orthotic insole after the removal of braces,without complaints of discomfort.At last follow-up,the VAS score,AOFAS ankle and hindfoot score and imaging related indexes were significantly improved compared with those before operation(P<0.01).Conclusion The application of subtalar joint stabilizer in the treatment of children with flexible flatfoot is simple,less invasive,safe and effective.

关 键 词：距下关节制动术 儿童 柔韧性平足 临床研究 

分 类 号：R684.3[医药卫生—骨科学]