跟骨骰骨楔骨截骨术治疗儿童柔韧性扁平足的疗效分析  

Efficacy analysis of calcaneo-cuboid-cuneiform osteotomy for flexible flatfoot in children

作　　者：胡雄科 梅海波 赵卫华 朱光辉 刘昆 谭谦 Hu Xiongke;Mei Haibo;Zhao Weihua;Zhu Guanghui;Liu Kun;Tan Qian(Department of Orthopedic,Affiliated Hunan Children's Hospital,Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Hunan Provincial Key Laboratory of Pediatric Orthopedics,Changsha 417000,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)骨科,湖南省儿童骨科学重点实验室,长沙417000

出　　处：《中华小儿外科杂志》2024年第8期739-743,共5页Chinese Journal of Pediatric Surgery

基　　金：湖南省自然科学基金项目(2023JJ30322);儿童骨科学湖南省重点实验室(2023TP1019);芙蓉实验室科技项目(2023SK2111)。

摘　　要：目的探讨跟骨骰骨楔骨截骨术治疗儿童柔韧性扁平足的临床疗效。方法回顾性分析2015年8月至2019年8月湖南省儿童医院收治的柔韧性扁平足12例(18足)患儿的临床资料,其中男7例,女5例。患儿全部采用跟骨骰骨楔骨截骨术(calcaneo-cuboid-cuneiform osteotomy,简称3C截骨术)进行手术治疗。记录术时年龄、手术时间、术中出血量、内固定装置取出时间及末次随访影像资料。采用视觉模拟评分量表(visual analogue scale,VAS)和改进的美国骨科足踝协会(American Orthopedic Foot Ankle Society,AOFAS)评分量表来评估临床结局。测量并比较足负重正侧位X线片上的6个参数,包括正位距骨第一跖骨角、侧位距骨第一跖骨角、正位距骨跟骨角、侧位距骨跟骨角、距舟覆盖角和跟骨倾斜角。结果12例患儿手术时年龄为(11.7±3.6)岁,手术时间为(93.1±15.8)min,术中出血(41.9±19.9)ml,内固定装置取出时间为(13.2±7.0)个月。所有患儿术后随访至少22个月,平均时长为31个月。患儿术前VAS疼痛评分为(5.08±0.36)分,比末次随访时的(0.92±0.19)分显著下降(P<0.05)。患儿术前AOFAS评分为(42.9±6.7)分,比末次随访时的(82.9±6.3)分显著上升(P<0.05)。术后6项影像学测量指标中有5项较术前显著改善,正位距骨第一跖骨角、侧位距骨第一跖骨角、正位距骨跟骨角、距舟覆盖角和跟骨倾斜角,差异具有统计学意义(P<0.01)。所有患儿术后未出现截骨不愈合、骨髓炎、伤口感染等严重并发症,12例患儿中有11例取得令人满意的结局。结论3C截骨术治疗儿童柔韧性扁平足有满意的疗效,没有严重的并发症。Objective To retrospectively evaluate the clinical efficacies and radiological outcomes of calcaneo-cuboid-cuneiform osteotomy for flexible flatfeet in children.Methods From August 2015 to August 2019,a total of 12 children(18 feet)with flexible flatfoot underwent calcaneo-cuboid-cuneiform osteotomy(3C osteotomy).Operative age,operative duration,intraoperative volume of blood loss,duration until removal of internal fixation and the latest follow-up imaging data were recorded.Clinical outcomes were evaluated by Visual Analog Scale(VAS)pain score and modified American Orthopedic Foot&Ankle Society Scale(AOFAS).A total of 6 parameters on anteroposterior(AP)and lateral radiographs of foot in weight loading were compared,including AP talo-first metatarsal angle,lateral talo-first metatarsal angle,AP talocalcaneal angle,lateral talocalcaneal angle,talo-navicular coverage angle and calcaneal pitch angle.Results Mean operative age was(11.7±3.6)year,mean operative duration(93.1±15.8)min,mean volume of intraoperative blood loss(41.9±19.9)ml and mean duration until removal of internal fixation(13.2±7.0)months.All of them were followed up for at least 22 months with an average of 31 months.Preoperative VAS pain score dropped sharply from(5.08±0.36)to(0.92±0.19)at the final follow-up(P<0.05).Preoperative AOFAS score improved significantly from(42.9±6.7)to(82.9±6.3)at the final follow-up(P<0.05).Postoperatively,5/6 radiographic parameters showed significant improvements as compared with preoperative values(P<0.01).There was no postoperative instance of nonunion,osteomyelitis or wound infection.And 11/12 cases achieved satisfactory outcomes.Conclusion 3C osteotomy may achieve satisfactory outcomes for flexible flat feet in children without serious complications.

关 键 词：扁平足 截骨术 跟骨 骰骨 儿童 

分 类 号：R726.8[医药卫生—儿科]