副舟骨切除结合胫后肌腱止点前置重建治疗副舟骨源性平足症

EXCISION OF ACCESSORY NAVICULAR WITH RECONSTRUCTION OF POSTERIOR TIBIAL TENDON INSERTION ON NAVICULAR FOR TREATMENT OF FLATFOOT RELATED WITH ACCESSORY NAVICULAR

目的探讨副舟骨切除结合胫后肌腱止点前置重建治疗副舟骨源性平足症的方法及临床疗效。方法 2006年5月-2011年6月,收治33例(40足)经6个月以上保守治疗无效的副舟骨源性平足症患者。男14例(17足),女19例(23足);年龄16～56岁,平均30.1岁。均有双侧副舟骨,其中单侧发病26例,双侧7例。出现平足症状至入院时间为7个月～9年,中位时间24个月。中足功能采用美国矫形足踝协会(AOFAS)评分标准评定为(47.9±7.3)分。X线片检查示,均有足部Ⅱ型副舟骨,足弓高度不同程度丢失,均伴后足轻度畸形。术中切除副舟骨,行胫后肌腱止点前置带线锚钉重建术治疗。结果术后患者切口均Ⅰ期愈合,无相关并发症发生。术后30例(36足)患者获随访,随访时间6～54个月,平均23个月。患者术后6个月足部疼痛均消失,足部外观明显改善。末次随访时中足功能AOFAS评分为(90.4±2.0)分,与术前比较差异有统计学意义(t=29.73,P=0.00)。X线片检查,均无内固定锚钉松动、断裂等发生;足弓高度、跟骨倾斜角、跟距角及距骨-第1跖骨角与术前比较,差异均有统计学意义(P<0.01)。结论采用副舟骨切除结合胫后肌腱止点前置重建治疗副舟骨源性平足症可有效纠正平足畸形,足功能恢复好,并发症少。

Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its e ectiveness.Methods Between May 2006 and June 2011,33 patients（40 feet） with atfoot related with accessory navicular were treated.There were 14 males（17 feet） and 19 females（23 feet） with an average age of 30.1 years（range,16-56 years）.All patients had bilateral accessory navicular;26 had unilateral atfoot and 7 had bilateral atfeet.The disease duration ranged from 7 months to 9 years（median,24 months）.The American Orthopaedic Foot and Ankle Society（AOFAS） ankle-midfoot score was 47.9 ± 7.3.The X-ray lms showed type II accessory navicular,the arch height loss,and heel valgus in all patients.All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor.Results All patients got primary wound healing without any complication.Thirty patients（36 feet） were followed up 6-54 months with an average of 23 months.All patients achieved complete pain relief at 6 months after surgery and had good appearance of the feet.The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up,showing signi cant di erence when compared with preoperative score（t=29.73,P=0.00）.X-ray lms showed that no screw loosening or breakage was observed.There were signi cant di erences in the arch height,calcaneus inclination angle,talocalcaneal angle,and talar-rst metatarsal angle between pre-operation and last follow-up（P 0.01）.Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of atfoot related with accessory navicular,with correction of deformity,excellent e ectiveness,and less complications.