先天性马蹄内翻足跖骨排列与改良Mckay术后前足内收畸形的关系

The association of metatarsal alignment with forefoot adduction in children with CTEV undergoing modified Mckay procedure

目的:探讨先天性马蹄内翻足(CTEV)患儿的跖骨排列改变以及其与改良Mckay术后前足内收的关系。方法:对2000-2004年间我院行改良Mckay术治疗的CTEV患儿的患足摄术前、术后以及对照组健康足摄正位X线平片,根据自行拟定的标准进行测量前半足中轴线与各跖骨轴线的夹角及其与内外踝连线垂线的夹角,并进行对比、分析。结果:58例健康足的前半足中轴线分别与第1～5跖骨中轴线夹角的平均值均<5°,而患足与健康足之间比较,差异有显著性(χ2=77.09,P<0.01),证实CTEV的跖骨排列存在紊乱情况。术前跖骨排列紊乱程度与术后前足内收程度有关,差异具有显著性(χ2=9.928,P<0.05)。随着术前跖骨排列紊乱程度的加重,术后前足内收的危险性增高。结论:CTEV患足的跖骨排列存在一定程度的紊乱,其紊乱程度是造成术后前足残留内收畸形或畸形复发的主要原因之一。

Objective To explore the changes of metatarsal arrangement and their association with forefoot adduction after modified Mckay procedure. Methods Radiographs of the affected feet were taken before and after the modified Mckay procedure performed on the children with CTEV from 2000 through 2004, so were those of the normal control feet. According to the self-established criteria, the angles between the midline of the forefoot and the midline of each of the five metatarsal bones and the angle between the midline of the forefoot and the line perpendicular to the transverse line joining the distal fibula and tibia were measured. The results were analyzed and compared. Results The degree of adduction was categorized as mild, moderate, and severe based on the angle between the midline of the forefoot and the line perpendicular to the transverse line joining the distal fibula and tibia. The association of abnormal metatarsal alignment with postoperative forefoot adduction was confirmed based on the angles between the midline of the forefoot and the midline of each of the five metatarsal bones. Conclusion Children with CTEV have some disarrangement of the metatarsals and the degree of disarrangement is one of the major causes of postoperative forefoot adduction or recurrence of the deformity.