基层官兵Ⅱ型疼痛性足副舟骨改良Kinder手术疗效

Curative effect of modified Kinder surgery on type Ⅱ painful accessory navicular bones among grass-roots servicemen

目的评估改良Kinder手术治疗基层官兵Ⅱ型疼痛性足副舟骨的手术效果。方法回顾2016-07至2018-06武警北京总队医院治疗的27例Ⅱ型疼痛性足副舟骨患者,均为男性,年龄18~29岁,平均(22.6±3.2)岁,病程6~18个月,平均(8.6±2.4)个月,左侧12例,右侧15例,其中合并轻度扁平足5例。采用改良Kinder手术治疗,对手术前后资料进行整理,正位X线片测量距舟覆盖角、距骨第2跖骨角,侧位X线片测量距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角),并通过视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)中足功能评分对手术效果进行量化。结果本研究中27例均获得随访,随访时间12~24个月,平均(10.7±4.2)个月;未出现感染、内固定失效、下肢深静脉血栓等并发症;末次随访患足疼痛症状消失21例,明显缓解6例;27例足活动范围均正常。距舟覆盖角由术前平均18.81°±2.66°减少至末次随访时平均13.26°±3.02°,差异有统计学意义(t=9.188,P<0.001);距骨第2跖骨角由术前平均14.41°±2.41°减少至末次随访时平均7.07°±1.66°,差异有统计学意义(t=17.887,P<0.001);Meary角由术前平均3.07°±1.07°减少至末次随访时平均2.81°±0.786°,差异无统计学意义(t=1.657,P=0.110);Pitch角由术前平均20.89°±2.90°提高至末次随访时平均21.89°±1.94°,差异无统计学意义(t=-1.997,P=0.056);VAS评分由术前平均(6.15±1.03)分降低至末次随访时平均(1.52±0.94)分,差异有统计学意义(t=20.360,P<0.001);AOFAS中足功能评分由术前平均(47.19±5.31)分提高至末次随访时平均(86.67±4.38)分,差异有统计学意义(t=-31.939,P<0.001)。结论采用改良Kinder手术治疗基层官兵Ⅱ型疼痛性足副舟骨,疼痛缓解明显,并发症少,效果好。

Objective To assess the therapeutic effect of modified Kinder surgery against typeⅡpainful accessory navicular bones(PANBs)among grass-roots officers and soldiers.Methods The clinical data on 27 patients with typeⅡPANBs treated in Beijing Municipal Crops Hospital of PAP between July 2016 and June 2018 was retrospectively analyzed.All the patients were males aged 18 to 29,with an average age of(22.6±3.2)years.The duration of the disease ranged from 6 to 18 months,with an average of(8.6±2.4)months.PANBs occurred on the left side in 12 cases and on the right side in 15 cases,including 5 patients with mild flat feet.The modified Kinder surgery was adopted before the data before and after operation was collected.The orthotopic radiographs were used to measure the talonavicular coverage angle,the talar-second metatarsal angle.Lateral radiographs were used to measure the talar-first metatarsal angle(Meary angle)and the calcaneus inclination angle(Pitch angle).The effect of surgery was quantified with the visual analog scale(VAS)and the American Orthopaedic Foot and Ankle Surgery Association(AOFAS)Midfoot Score.Results In this study,27 patients were followed up for 12 to 24 months,with an average of(10.7±4.2)months.There were no complications,such as infection,internal fixation failure or deep venous thrombosis of lower limbs.During the last follow-up,it was found that foot pain had disappeared in 21 cases of,and pain was significantly alleviated in 6 cases.The range of foot movement became normal in each of the cases.On average,the talonavicular coverage angle was reduced from 18.81°±2.66°preoperatively to 13.26°±3.02°during the last follow-up,and the difference was statistically significant(t=9.188,P<0.001).The talar-second metatarsal angle was reduced from 14.41°±2.41°to 7.07°±1.66°,and the difference was statistically significant(t=17.887,P<0.001).The Meary angle decreased from 3.07°±1.07°preoperatively to 2.81°±0.786°,but there was no significant difference(t=1.657,P=0.110).The Pitch angle increased from 20.89°±2.90°to 21.89°±1.94°,but with no significant difference(t=-1.997,P=0.056).The VAS pain score decreased from 6.15±1.03 to 1.52±0.94,and the difference was statistically significant(t=20.360,P<0.001).The AOFAS Midfoot Score improved from 47.19±5.31 to 86.67±4.38,and the difference was statistically significant(t=-31.939,P<0.001).Conclusions It is recommended that the modified Kinder surgery be used to treat typeⅡpainful accessory navicular bones in grass-roots officers and soldiers,with obvious pain relief,fewer complications,and good efficacy.