关节融合术治疗中足骨折脱位致平足症的疗效

Arthrodesis for traumatic flat foot caused by midtarsal fracture dislocation

目的探讨中足天节融合术治疗陈旧性中足骨折脱位致创伤性平足疵的临术疗效方法2009年1月至2011年10月采川关节融合术治疗陈旧性中足损伤后成人创伤性平足症15例，其中男10例，女5例；年龄22～57岁，平均38．4岁；左足8例，右足7例。比较术前和末次随访11寸址闭5力线政变情况，并采川美同足踝外科阱会（AOFAS）中足评分和视觉模拟评分（VAS）评估功能预后结果12例忠行术后获平均23个月（12．37个月）随访。木次随访时距骨一第1跖骨角（14．7°±3．7°）、距骨第2跖骨角（18．9°±2．9°）、距骨．跖骨角（3．4°±1．2°）较术前（26．1°±8．9°、28．6°±12．7°、10．7°±6．7°）减小，羞件均有统计学意义（P〈0．05）。末次随访时距骨一跟骨ffI（24．6°±4．3°）较术前（21．3°±4．7°）增加，差砰无统计学意义（P〉0．05）。术次随访时AOFAS中足评分[（81．5±6．3）分l、vAS评分I（2．6±0．9）分I较术前[（30．5±14．9）分、（5．7±0．9）1明显改善，差异均有统计学息义（P〈0．05）结论 中足融合术可以明显改善创伤性平足症患者的足部力线和外形，稳定足弓，且可较好地缓解临床症状，但多数患者仍无法完全恢复伤前活动能力，早期诊断和合理治疗对中足骨折脱何仍非常关键。

Objective To evaluate the short to mid-term outcomes of arlhrodesis for traumatic flat Joot caused hv midtal,al fraelure dislocation. Methods From January 2009 to October 2011, 15 patients with traumatic flat fot caused by midtarsal fracture dislocation were treated by arthrodesis in our department. They were 10 males and 5 hmmles, with a mean age of 38.4 years （range, 22 to 57 years） . Eighl flat feet were left and 7 were right. A ret,＇ospective analysis was performed to evaluate alignment of the treated foot between preand post-operation and functional recovery at the final follow-up using the American Orthopaedie Fool and Ankle Society （AOFAS） mid-foot score and visual analogue scale （VAS）, Results A total of 12 eases were followed for a mean time of 23 months （range, 12 to 37 months）. The first and second metatarsal angles were signifieanlly improved （ P 〈 0.05） on Ihe anterior-posterior X-ray fihns of weight-bearing foot. On the lateral X-ray films of weight-bearing foot, the Meary＇ s angle was also significantly improved （ P 〈0. 05） but the taloealeaneal angle was improved with no significant difference. The mean postperative AOFAS mid-foot score was significantly higher tha,i the we-operative one （30.5 ±14. 9 vs. 81.5± 6.3, P 〈0. 05）. The meanAS score was significantly improved too （ P 〈 0.05）. Calcaneocuboid joint nonunion was found in one patient and skin necrosis in 2 but no deep infection or osteomyelitis was found. Conclusions Midtarsal arthrodesis can significantly improve the alignment of a traumatic flat fnot caused by midtarsal fracture dislocation, stabilize the areh of foot and improve Ihe symptoms. However, most of the patients can nol reach the pro-injury motion level, and earl） diagnosis and rational treatment are still important to patients with midtarsal injury.