全后足关节镜下距下关节融合治疗成人疼痛性跟距骨桥的临床效果  

Posterior arthroscopic subtalar arthrodesis for symptomatic adult talocalcaneal coalition

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

机构地区：[1]徐州市中心医院手足显微外科徐州医科大学徐州临床学院,徐州221009

出　　处：《中华外科杂志》2023年第11期976-981,共6页Chinese Journal of Surgery

摘　　要：目的:探讨全后足关节镜下距下关节融合治疗成人疼痛性跟距骨桥的临床效果。方法:回顾性分析2018年3月到2022年2月于徐州市中心医院手足显微外科采用全后足关节镜下距下关节融合技术治疗的17例(17足)成人疼痛性跟距骨桥患者的临床资料。其中男性10例,女性7例,年龄(42.4±7.5)岁(范围:31~58岁)。右侧9例,左侧7例。RozanskyⅠ型4例,RozanskyⅡ型7例,RozanskyⅢ型3例,RozanskyⅣ型3例。观察患者术后切口愈合情况及距下关节骨性愈合情况,采用疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、健康状况调查简表(SF-36)评分评估患肢疼痛和功能情况。数据比较采用配对样本t检验。结果:所有患者均获得随访,随访时间(24.8±6.9)个月(范围:12~40个月),无切口感染、深静脉血栓、骨不连、螺钉断裂等并发症发生。1例术前合并腓骨肌痉挛患者,自述术后长时间行走后仍可诱发腓骨肌痉挛,予腓骨短肌延长后症状完全消失。距下关节骨性愈合时间(8.8±2.2)周(范围:6~12周)。末次随访时VAS由术前的(6.4±1.3)分降至(1.3±0.9)分(t=14.114,P<0.01);AOFAS踝-后足评分由术前的(49.0±8.1)分升至(90.0±5.1)分(t=38.782,P<0.01);SF-36评分由术前的(50.8±9.5)分升至(91.0±4.9)分(t=20.468,P<0.01),差异均有统计学意义。结论:全后足关节镜下距下关节融合技术,具有创伤小、恢复快、并发症少等优点,可用于成人疼痛性跟距骨桥的治疗。Objective To investigate the functional outcomes of posterior arthroscopic subtalar arthrodesis(PASTA)for adult patients presenting with symptomatic talocalcaneal coalition.Methods The study was a retrospective case-series research.The data of 17 adult patients(17 feet)with symptomatic talocalcaneal coalitions,treated with PASTA from March 2018 to February 2022 in Xuzhou Central Hospital were collected.This procedure involved 10 males and 7 females,aged(42.4±7.5)years(range:31 to 58 years).There were 9 cases on the right side and 7 cases on the left side.According to the Rozansky classification,there were 4 cases of typeⅠ,7 cases of typeⅡ,3 cases of typeⅢ,3 cases of typeⅣ.The following items such as wound healing and bony union of the subtalar joint were observed.Clinical assessment was performed using pain visual analogue scale(VAS),American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scores and 36-item short form health survey(SF-36)scores.The paired t test was used for data comparison.Results The follow-up time was(24.8±6.9)months(range:12 to 40 months).There were no complications such as wound infection,deep vein thrombosis,nonunion,or screw breakage.One patient with preoperative spasm,relieved after the second surgical procedure(peroneal brevis tendon lengthening).The union time of the subtalar joint was(8.8±2.2)weeks(range:6 to 12 weeks).At the final follow-up,the VAS decreased from 6.4±1.3 to 1.3±0.9(t=14.114,P<0.01),the AOFAS ankle-hindfoot score increased from 49.0±8.1 to 90.0±5.1(t=38.782,P<0.01),and the SF-36 score increased from 50.8±9.5 to 91.0±4.9(t=20.468,P<0.01).Conclusion PASTA for adult patients presenting with symptomatic talocalcaneal coalition offers advantages of minimal trauma,fast recovery,and few complications,which is an effective method.

关 键 词：跟骨 距骨 跟距骨桥 关节镜 融合 

分 类 号：R687.3[医药卫生—骨科学]