跟骨内移截骨治疗获得性扁平足临床分析

Acquired flat foot medial displacement calcaneal osteotomy

[目的]探讨跟骨内移截骨治疗扁平足的要点及临床疗效。[方法]自2006年1月~2009年12月,采取跟骨内移截骨及联合手术治疗扁平足31例,男17例,女14例;年龄19~50岁（平均26.7岁）。术前均摄足侧位及跟骨轴位X线片及跟骨CT,测量第1跖距角5°~32°（平均22.3°）。均有跟腱挛缩、外移、跟骨外翻、前足旋前外展（负重位外观）,有疼痛,根据美国矫形足踝协会（AOFAS）踝后足评分标准评分平均45.8分。胫后肌腱功能不全均二级。单纯跟骨内移截骨13例,跟骨内移截骨加跟腱延长4例,跟骨内移截骨加跟腱延长及趾长屈肌腱移位14例。[结果]术后随访6~26个月（平均18.8个月）,内侧纵弓较手术前增加,内侧柱高度由术前（8.5±3.2）mm增至（16.3±4.1）mm（t=8.35,P≤0.001）,10例疼痛消失,15例减轻,6例无明显改变。第1跖距角由术前5°~32°（平均22.3°±4.5°）降至0°~7°（平均3.2°±1.4°）（t=22.57,P≤0.001）。足外翻及外展明显改善,有效率80.6%（25？31）,（AOFAS）踝后足评分平均84.5分。[结论]跟骨体部截骨手术治疗可屈性平足症,能够可靠地纠正平足症的跟骨外翻畸形,部分恢复其内侧纵弓,改善足的负重和足踝部生物力学特性,术中根据情况联合其他术式提高疗效,同时应严格掌握适应证。

[Objective]To study the characteristic and clinic curative effect of the acquired flatfoot treated by a medial displacement calcaneal osteotomy. [Methods]From Jan.2006~Dec.2008,31 patients with an average age of 26.7 years（range,19～50 years）,were treated by a medial displacement calcaneal osteotomy together with other technique.Seventeen of them were male and 14 were female.The lateral position,calcaneal axial and CT of calcaneal were taken preoperatively.The mean first talocalcaneal angle was 22.3°（range,5°～32°）.All patients had contracture of achilles tendon,posterior tibial tendon dysfunction,calcaneovalgus,forefoot pronation and abduction（weight bearing） and pains.The American Orthopaedic Foot and Ankle Society（AOFAS） Hindfoot Scale was 45.8.Posterior tibial tendon insufficiency（PTTI） were stage II.Thirteen feet were treated by a medial displacement calcaneal osteotomy,4 feet by a medial displacement calcaneal osteotomy and tendocalcaneus lengthening,14 feet by a medial displacement calcaneal osteotomy,tendo calcaneus lengthening and flexor digitorum longus tendon transfer.[Results]After a mean follow up of 18.8 months（range,6～26 months）,the medial longitudinal arch improved postoperatively,10 feets pain disappeared,15 foot reliefed and 6 foot remained.The mean first talocalcaneal angle was 3.2°（range,0°～7°）（t=22.57,P≤0.001）,strephexopodia and the abduction of foot obviously improved.The rating of clinic curative effect was 80.6%（25/31）.The American Orthopaedic Foot and Ankle Society（AOFAS） Hindfoot Scale was 84.5.[Conclusion]Medial displacement calcaneal osteotomy treating the flexible flatfoot can reliablely correct calcaneovalgus,partly resume the medial longitudinal arch,improve weight bearing and biomechanical characteristic of foot and ankle.We can combine with other technique to improve curative effect of the acquired flat foot.The operative indication should be strictly selected.