弹簧韧带修复治疗少儿柔韧性扁平足疗效观察  

Effectiveness of spring ligament repair in treatment of children’s flexible flatfoot

作　　者：贾荣志 张洋 赵永杰 刘颖[1] 孙广超[1] JIA Rongzhi;ZHANG Yang;ZHAO Yongjie;LIU Ying;SUN Guangchao(Department of Foot and Ankle Surgery,Binzhou Medical University Hospital,Binzhou Shandong,256603,P.R.China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603

出　　处：《中国修复重建外科杂志》2025年第4期406-411,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：山东省医药卫生科技发展计划项目(202104070986)。

摘　　要：目的探讨弹簧韧带修复并距下关节制动术(subtalar arthroereisis,STA)联合Kidner术治疗少儿柔韧性扁平足合并痛性副舟骨的临床疗效。方法回顾分析2018年2月—2022年5月收治且符合选择标准的45例(45足)7~14岁柔韧性扁平足合并痛性副舟骨患儿临床资料。其中23例(23足)采用弹簧韧带修复并STA联合Kidner术治疗(观察组),22例(22足)采用单纯STA联合Kidner术治疗(对照组)。两组患儿性别、年龄、侧别、术前疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)评分、距舟覆盖角(talonavicular coverage angle,TCA)、距骨-第1跖骨角(talus-first metatarsal angle,T1MT)、距骨-第2跖骨角(talus-second metatarsal angle,T2MT)、距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、切口长度、住院时间、完全负重行走时间及并发症发生情况;术前及末次随访时采用VAS评分及AOFAS评分评价患儿足部疼痛及功能恢复情况,并测量TCA、T1MT、T2MT、Meary角、Pitch角等影像学指标,以术前与末次随访时差值进行分析。结果两组患儿均顺利完成手术,未发生血管、神经、肌腱损伤等手术相关并发症。观察组手术时间长于对照组,差异有统计学意义(P<0.05);两组术中出血量、切口长度、住院时间及负重行走时间比较差异无统计学意义(P>0.05)。两组患儿均获随访,随访时间23~47个月,平均33.7个月。对照组1例患儿患足出现行走不适感,考虑与螺钉对跗骨窦的刺激有关,经康复训练后于术后2~3个月症状逐渐消失;其余患儿均未出现跗骨窦螺钉脱出、腓肠肌挛缩、切口感染等并发症。末次随访时,观察组影像学指标(TCA、T1MT、T2MT、Meary角、Pitch角)及VAS评分、AOFAS评分手术前后差值均显著优于对照组,差异有统计学意义(P<0.05)。结论弹簧韧带修复并STA联合Kidner术治疗少儿Objective To investigate the effectiveness of spring ligament repair combined with subtalar arthroereisis(STA)and the Kidner procedure for treating children’s flexible flatfoot with painful accessory navicular.Methods A retrospective analysis was conducted on clinical data from 45 children(45 feet)aged 7-14 years with flexible flatfoot and painful accessory navicular who met the selection criteria and were treated between February 2018 and May 2022.Among them,23 cases(23 feet)were treated with spring ligament repair combined with STA and Kidner procedure(observation group),while 22 cases(22 feet)received STA with Kidner procedure alone(control group).Comparison of baseline data between the two groups including gender,age,affected side,preoperative visual analogue scale(VAS)score,American Orthopaedic Foot&Ankle Society(AOFAS)score,talonavicular coverage angle(TCA),talus-first metatarsal angle(T1MT),talus-second metatarsal angle(T2MT),talus first plantar angle(Meary angle),calcaneal inclination angle(Pitch angle)showed no significant differences(P>0.05).The following parameters were recorded and compared between the two groups:operation time,intraoperative blood loss,incision length,hospital stay,time to full weight-bearing,and complication rates.Foot pain and functional recovery were assessed using the VAS score and AOFAS score preoperatively and at last follow-up.Radiographic measurements including TCA,T1MT,T2MT,Meary angle,and Pitch angle were analyzed by comparing preoperative to last follow-up values.Results Both groups of patients successfully completed the surgery without any procedure-related complications such as vascular,neural,or tendon injury.The operation time in the observation group was significantly longer than that in the control group(P<0.05).There was no significant difference between the two groups in terms of intraoperative blood loss,incision length,hospital stay,or time to full weight-bearing(P>0.05).All patients were followed up 23-47 months(mean,33.7 months).In the control group,1 patient

关 键 词：距下关节制动术 弹簧韧带 少儿 柔韧性扁平足 副舟骨 

分 类 号：R726.8[医药卫生—儿科]