跟骨延长截骨术治疗症状性扁平外翻足

Calcaneal lengthening osteotomy for the treatment of symptomatic flexible flatfoot

目的介绍扁平外翻足采用跟骨延长截骨术治疗的手术指征和方法，对结果作出评价，并讨论其矫正机制和矫形效果。方法2009年1月至今我科共治疗症状性扁平外翻足13例19足，男6例，女7例，单纯性扁平外翻足6例10足，神经肌肉性扁平外翻足7例9足。年龄8～12岁，平均9岁10个月。术前均经第一跖趾关节背屈试验和Jack足趾站立试验判定为柔软性扁平外翻足，疼痛经1～2年的保守治疗无效。采用跟骨延长截骨术治疗，并根据畸形的程度给予不同的软组织重建手术。结果所有患儿术后平均随访2年7个月，采用美国AOFAS踝与后足功能评分标准评价临床结果，平均得分92分，15足优，4足良。X线评价测定术前及末次随访时足负重正侧位片的跟距角，距骨第一跖骨夹角及跟骨倾斜角，取平均值后，采用t检验进行统计学分析，差异均有统计学意义。未出现骨连接延迟或不连接，无截骨处移位，骨块吸收，畸形复发，跟骨缺血坏死等并发症。结论跟骨延长截骨术是一种保留关节的重建手术，治疗症状性柔软性扁平外翻足疗效确切且并发症少。对于神经肌肉性患儿，适当的软组织重建是确保手术成功的关键。

Objective To introduce the indication and technique of calcaneal lengthening osteot- omy for children with symptomatic flexible flatfoot. Methods From January 2009, calcaneal lengthe- ning osteotomy was performed on 19 feet of the 13 patients in pediatric orthopedic department in Shanghai Children＇s Medical Center. All patients were diagnosed with symptomatic flexible flatfoot and failed to response to the conservative treatment. Among these patients, 6 were males and 7 were fe- males. Ten feet of 6 patients were diagnosed as idiopathic flatfeet, and 9 feet of 7 patients were neuro- muscular pes planovalgus. The average age was 9 years and 10 months old. The calcaneal osteotomy lengthening combined with soft tissue reconstruction was performed to balance the muscle force and correct the deformities of the hindfoot and forefoot of the patients. Results The mean follow-up period was 2 years and 9 months. The effectiveness of surgery was judged by evaluating ankle and hindfoot function using AOFAS Ankle-Hindfoot Scale system. The average score of the patients was 92. The ankle and hindfoot function was excellent in 15 feet and good in 4 feet. No complication was observed. Satisfied orthopedic effects on the intermetatarsal angle, the metatarsal-phangeal angle and the appear- ance of the foot were confirmed during follow-up. Conclusions Calcaneal lengthening is effective for the correction of severe, intractably symptomatic flexible flatfoot in children.