骰骨截骨外侧柱延长术联合附加术式治疗平足症的短期疗效分析  

Short-term efficacy of lateral column lengthening via cuboid osteotomy combined with additional procedures for the flatfoot

作　　者：丁楠 樊晓晨 鹿军 梁晓军 DING Nan;FAN Xiaochen;LU Jun;LIANG Xiaojun(Department of TCM Rehabilitation,Xi'an Honghui Hospital,Xi'an 712046,China;Foot and Ankle Surgery Center,Xi'an Honghui Hospital,Xi'an 710054,China)

机构地区：[1]西安市红会医院中医康复科,西安710000 [2]西安市红会医院足踝外科诊疗中心,西安710004

出　　处：《中华骨与关节外科杂志》2024年第9期831-836,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:评估骰骨截骨外侧柱延长术联合附加术式治疗平足症的短期疗效。方法:回顾性分析2019年10月至2021年9月西安市红会医院收治的采用骰骨截骨外侧柱延长术联合附加术式治疗的14例平足症患者(14足)的临床资料。其中男6例,女8例,年龄12~38岁,平均(24.3±5.2)岁。患者典型临床表现为前足外展、后足外翻、内侧足弓塌陷及外侧柱短缩。比较术前与末次随访时疼痛视觉模拟评分(VAS)、Maryland评分、美国足踝外科协会(AOFAS)踝-后足评分。术前及末次随访时拍摄患足站立位正、侧位X线片及后足Saltzman位X线片。于足站立位正位X线片上测量距骨-第1跖骨角(T1MT)、距骨-第2跖骨角(T2MT)、距舟覆盖角(TNCA),于足站立位侧位X线片上测量距骨-第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)、跟骨-距骨角(Kite角),于后足Saltzman位X线片上测量Saltzman外翻角,并进行比较。结果:本研究10例患者联合行跟骨内移截骨术,4例患者联合行弹簧韧带修补紧缩术,4例患者联合行胫后肌腱加强术,3例患者联合行距舟关节融合术,2例患者联合行距下关节融合术,1例患者联合行跟腱延长术(腓肠肌腱膜松解术),1例患者联合行Cotton截骨术。术后1例患者出现切口浅表感染,口服抗生素1周后愈合;2例患者出现骰骨外侧金属激惹疼痛,1例患者出现第5跖跗关节疼痛。所有患者均获得随访,随访时间12~18个月,平均(14.6±3.2)个月。末次随访时患者VAS评分较术前降低,Maryland评分、AOFAS踝-后足评分均较术前提高,T1MT角、T2MT角、TNCA角、Meary角、Kite角、Pitch角均较术前改善,差异均有统计学意义(P均<0.01)。结论:骰骨截骨外侧柱延长术联合附加术式治疗平足症短期疗效良好,可以较好地改善平足畸形。Objective:To evaluate the short-term efficacy of lateral column lengthening via cuboid osteotomy combined with additional procedures for flatfoot.Methods:A retrospective analysis was conducted on 14 patients(14 feet)with flatfoot who underwent lateral column lengthening with cuboid osteotomy and additional procedures at Xi'an Honghui Hospital from October 2019 to September 2021.There were 6 males and 8 females,with an average age of 24.3±5.2 years(range,12-38 years).The typical clinical manifestations included forefoot abduction,hindfoot valgus,collapse of the medial arch,and shortening of the lateral column.Pain visual analog scale(VAS),Maryland score,and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score were compared at baseline and the final follow-up.The weight-bearing anteroposterior and lateral radiographs of the affected foot and Saltzman view of the hindfoot were taken at baseline and the final follow-up.The talus-first metatarsal angle(T1MT),talus-second metatarsal angle(T2MT),and talonavicular coverage angle(TNCA)were measured on the weight-bearing anteroposterior radiographs.The Meary angle(talus-first metatarsal angle),calcaneal pitch angle(Pitch angle),and talocalcaneal angle(Kite angle)were measured on lateral radiographs.The Saltzman valgus angle was measured on Saltzman views of the hindfoot.These measurements were compared between groups.Results:Additional procedures performed included medial displacement calcaneal osteotomy(10 patients),spring ligament repair and tightening(4 patients),posterior tibial tendon strengthening(4 patients),talonavicular joint fusion(3 patients),subtalar joint fusion(2 patients),Achilles tendon lengthening(gastrocnemius fascia release)(1 patient),and Cotton osteotomy(1 patient).Postoperative complications included one case of superficial wound infection,which healed after 1 week of oral antibiotics,two cases of allergic reactions to the lateral cuboid metallic implants,and 1 case of pain in the fifth tarsometatarsal joint.All patients were follow

关 键 词：平足症 外侧柱延长 截骨 短期疗效 

分 类 号：R682.6[医药卫生—骨科学]