截骨联合软组织平衡治疗进行性神经性腓骨肌萎缩症致柔韧性高弓足畸形  

Osteotomy combined with soft tissue balancing for flexible cavovarus foot deformity secondary to Charcot-Marie-Tooth disease

作　　者：温晓东 刘承义 聂光华 田锋[1] 赵恺[1] 李毅[1] WEN Xiaodong;LIU Chengyi;NIE Guanghua;TIAN Feng;ZHAO Kai;LI Yi(Department of Foot and Ankle Surgery,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科,西安710054

出　　处：《中华骨与关节外科杂志》2024年第12期1112-1118,共7页Chinese Journal of Bone and Joint Surgery

基　　金：陕西省重点研发计划一般项目(2022SF-532,2023YBSF-488);陕西省卫生健康科研基金(2022A005);西安市卫健委面上项目(2023MS15)。

摘　　要：目的:探讨截骨联合软组织平衡治疗进行性神经性腓骨肌萎缩症(CMT病)致柔韧性高弓足畸形的临床效果。方法:回顾性分析2018年8月至2021年8月于西安交通大学附属红会医院行截骨联合软组织平衡手术治疗的25例(30足)CMT病致柔韧性高弓足畸形患者的临床资料,其中男18例,女7例;年龄16~42岁,平均(33.1±8.3)岁。比较患者术前及术后1年随访的临床功能[包括美国足踝外科协会(AOFAS)踝−后足评分、Maryland足部评分和踝关节背伸及跖屈活动度(ROM)]及影像学参数[包括足负重正位X线片测量距骨-第1跖骨角,足负重侧位X线片测量Meary角、跟骨倾斜角、Hibbs角,标准Saltzman位X线片测量后足力线角],并记录术后1年并发症的发生情况。结果:所有患者均获得随访,随访时间为12~30个月,平均(18.3±7.5)个月。术后1年随访时,患者AOFAS踝与后足评分、Maryland足部评分均高于术前,踝关节背伸ROM大于术前,差异均有统计学意义(P均<0.05);术后1年随访时踝关节跖屈ROM与术前比较,差异无统计学意义(P>0.05)。术后1年随访时,患者距骨-第1跖骨角、Meary角、跟骨倾斜角及后足力线角均小于术前,Hibbs角大于术前,差异均有统计学意义(P均<0.05)。所有患者均未出现局部麻木、骨延迟愈合、骨不连、畸形愈合、内固定断裂、下肢深静脉血栓形成等手术相关并发症。结论:截骨联合软组织平衡治疗CMT病致柔韧性高弓足畸形,能够改善患者功能,有效矫正患者足踝部力线,临床效果显著。Objective:To evaluate the clinical and radiographic outcomes following osteotomy combined with soft tissue balancing for flexible cavovarus foot deformity secondary to Charcot-Marie-Tooth disease(CMT).Methods:A retrospective analysis was conducted on the clinical data of 25 patients(30 feet)with CMT-induced flexible cavovarus foot deformity who underwent osteotomy and soft tissue balancing at the Department of Foot and Ankle Surgery,Honghui Hospital Affiliated to Xi'an Jiaotong University from August 2018 to August 2021.The cohort included 18 males and 7 females,with a mean age of 33.1±8.3(ranging 16-42)years.The clinical outcomes[including the American Orthopaedic Foot&Ankle Society(AOFAS)Ankle-Hindfoot Scale,Maryland Foot Score,and range of motion(ROM)of ankle dorsiflexion and plantarflexion]and radiological parameters(including the talus-first metatarsal angle measured from weight-bearing anteroposterior X-rays;the Meary angle,calcaneal inclination angle,and Hibbs angle measured from weight-bearing lateral X-rays;and the hindfoot alignment angle measured from posterior foot Saltzman lateral X-rays)were compared preoperatively and at the 1-year follow-up.Results:All patients were followed for 12 to 30 months,with a mean of(18.3±7.5)months.At the 1-year follow-up,significant improvements were observed in the AOFAS Ankle-Hindfoot Scale,the Maryland foot score and the ROM of ankle dorsiflexion compared to preoperative values(all P<0.05).However,there was no statistically significant difference in the ankle plantar flexion ROM(P>0.05).Radiographic analysis at the 1-year follow-up revealed significant reductions in the talus-first metatarsal angle,Meary angle,calcaneal inclination angle,and hindfoot alignment angle,while a significant increase the Hibbs angle compared to preoperative measurements(all P<0.05).No patient experienced surgery-related complications such as local numbness,delayed bone healing,nonunion,malunion,internal fixation breakage,or deep vein thrombosis of the lower limbs.Conclusions:Osteotomy co

关 键 词：高弓足畸形 截骨 软组织平衡 柔韧性畸形 

分 类 号：R687.3[医药卫生—骨科学]