截骨矫形术与距下关节制动术治疗儿童柔韧性平足症的比较研究  

A Comparison Study on the Effectiveness of Osteotomy and Talotarsal Stabilization in the Treatment of Children’s Flexible Flatfoot

作　　者：王轩[1] 石超 曾秋[3] 李明秀 张运恒 常鑫 聂光华 李毅[3] Wang Xuan;Shi Chao;Zeng Qiu;Li Mingxiu;Zhang Yunheng;Chang Xin;Nie Guanghua;Li Yi(Second Clinical Medical College,Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,China;Department of Orthopaedics,Weinan Central Hospital,Weinan 714000,China;Department of Foot and Ankle Surgery,the Affiliated Honghui Hospital of Xi’an Jiaotong University,Xi’an 710054,China)

机构地区：[1]陕西中医药大学第二临床医学院,陕西咸阳712046 [2]渭南市中心医院骨科,陕西渭南714000 [3]西安交通大学院附属红会医院足踝外科,陕西西安710054

出　　处：《实用骨科杂志》2023年第7期592-597,602,共7页Journal of Practical Orthopaedics

基　　金：陕西省重点研发计划(2020SF-099);陕西省创新能力支撑计划(2021TD-59);陕西省重点研发计划一般项目-社会发展领域(2023-YBSF-488);西安市卫生健康委员会面上培育项目(2023ms15)。

摘　　要：目的比较截骨矫形术与距下关节制动术治疗儿童柔韧性平足症的临床疗效和手术安全性。方法回顾性分析2014年2月至2020年9月期间,在西安交通大学附属红会医院足踝外科分别接受截骨矫形术和距下关节制动术治疗的41例(61足)儿童柔韧性平足症患者的临床资料,年龄8~14岁,截骨矫形术组21例(31足),男11例,女10例;单侧11例,双侧10例;左足15例,右足16例;平均年龄(12.87±1.12)岁。距下关节制动组20例(30足),男12例,女8例;单侧10例,双侧10例;左足17例,右足13例;平均年龄(11.56±1.73)岁。对患儿术前和末次随访分别进行影像学评估,负重正位X线片上测量距骨第1跖骨角(talar 1st metatarsal angle,T1MT)和距舟覆盖角(talonavicular coverage angle,TNCA);负重侧位X线片上测量距骨第1跖骨角(Meary’s角)、跟骨倾斜角(calcaneal pitch angle,CPA)和后足力线Saltzman位X线片上测量跟骨外翻角(calcaneus valgus angle,CVA)。采用疼痛视觉模拟评分(visual analogue scale,VAS)、美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分评估两种手术治疗儿童柔韧性平足症的临床疗效。结果41例患者均得到有效随访,随访时间12~24个月,平均(18.1±7.3)个月。截骨矫形术组的跟骨倾斜角和跟骨外翻角改善幅度与距下关节制动术组比较,差异有统计学意义(P<0.05),其他指标差异无统计学意义(P>0.05)。结论截骨矫形术和距下关节制动术治疗儿童柔韧性平足症在影像学及功能改善方面均能取得满意的结果。Objective To explore and compare the clinical efficacy and surgical safety of osteotomy and subtalar arthroplasty in the treatment of childhood flexible flatfoot.Methods A retrospective analysis was conducted on the clinical data of 41(61 feet)children with flexible flatfoot who underwent either osteotomy or subtalar arthroereisis at the Department of Foot and Ankle Surgery,in The Affiliated Honghui Hospital of Xi’an Jiaotong University from February 2014 to September 2020.The osteotomy group consisted of 21 cases(31 feet),including 11 males and 10 females,with 11 cases of unilateral and 10 cases of bilateral involvement,15 cases of left foot and 16 cases of right foot.The average age of patients was(12.87±1.12)years.The subtalar arthroereisis group consisted of 20 cases(30 feet),including 12 males and 8 females,with 10 cases of unilateral and 10 cases of bilateral involvement,17 cases of left foot and 13 cases of right foot.The average age of patients was(11.56±1.73)years.Anteroposterior,lateral,and hindfoot alignment radiological images were measured in the X-ray weight-bearing position,including anteroposterior view upper talar 1st metatarsal angle(T1MT)and talonavicular coverage angle(TNCA),lateral view upper talus-first metatarsal angle(Meary’s angle),calcaneal pitch angle(CPA).Calcaneus valgus angle(CVA)at Saltzman position on the hind-foot line.Clinical assessment was performed using the visual analogue scale(VAS)and the American orthopaedic foot and ankle society(AOFAS)ankle-posterior foot function score.The clinical efficacy of these two kinds of surgery in the treatment of children’s flexible flat foot was compared and analyzed.Results All the 41 patients were effectively followed up for 12~24 months,with an average of(18.1±7.3)months.The improvement amplitude of calcaneal inclination angle and calcaneal eversion angle in osteotomy and orthopaedic group was significantly different from that in subtalar joint braking group(P<0.05),but no significant difference was found in other indexes(P>0.05).

关 键 词：儿童 柔韧性平足症 截骨矫形术 距下关节制动术 

分 类 号：R682.6[医药卫生—骨科学]