成人获得性平足的软组织重建

PROGRESS IN SOFT TISSUE RECONSTRUCTION OF ADULT-ACQUIRED FLATFOOT DEFORMITY

目的总结成人获得性平足(adult-acquired flatfoot deformity,AAFD)软组织重建的基础和临床研究进展。方法广泛查阅近年关于AAFD软组织修复和肌腱转移的相关文献,并进行综述。结果针对AAFD的软组织重建手术可分为静力性和动力性重建两种,其中静力性重建以弹簧韧带的修复重建为主;动力性重建术式较多,趾长屈肌腱转移术常用,但其生物力学效果欠佳,对于胫后肌功能正常的患者Cobb手术效果更佳。结论对于AAFD需根据畸形类型和分期选择软组织重建术式。

Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity （AAFD）. Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components： static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.