副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症

The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular

目的探讨副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症的临床疗效。方法2009年3月至2011年10月，采用副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症13例（16足），男4例，女9例；年龄18-64岁，平均41-3岁。单足10例，双足3例；均有明显的跟骨外翻。术后以美国足踝外科协会（AmericanOrthopaedicFootandAnkleSociety，AOFAS）踝与后足评分评估后足功能，于X线片上测量足弓高度、跟骨倾斜角（CI）、距跟角（TC）、距骨一第一跖骨角（TMT）。结果13例均获得随访，随访时间12-31个月，平均16．8个月。术后6个月时11例（13足）无任何疼痛，2例（3足）有长距离行走后足部疼痛。术后随访时AOFAS评分从术前（52．4±6.4）分提高至（88．1±2．8）分；负重侧位X线片上足弓高度从（3．8±0．3）mm提高至（12．0±1．1）mm，CI从9．5°±1．1°提高至20．1°±1．5°，TC从47-3°±2．5°改善至32．3°±2．5°，TMT从17．6°±1．6°改善至6．8°±1．0°；负重正位X线片上TC从39．5°±2-3°改善至26．2°±2．0°，TMT从15．2°±1．7°改善至6．3°±1．0°；轴位X线片上跟骨外翻角从11-3°±1．4°改善至4．2°±2．0°。结论对与副舟骨相关的平足症的治疗，当存在后足外翻畸形时，副舟骨切除胫后肌腱止点重建跟骨内移截骨术可以明显缓解疼痛，有效矫正畸形，近期疗效良好。

Objective To investigate the clinical outcomes of the medial displacement calcaneal os- teotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with ac- cessory navicular. Methods From March 2009 to October 2011, 13 patients （16 feet） with flatfoot related with accessory navicular received treatment by the medial displacement calcaneal osteotomy with reconstruc- tion of posterior tibial tendon insertion on navicular. There were 4 males and 9 females, with an average age of 41.3 years （range, 18-64 years）. All patients had obvious valgus calcaneus, the angle of which was 11.3°± 1.4°. According to AOFAS ankle-hindfoot scores, the arch height, calcaneus inclination angle （CI）, talocal- caneal angle （TC）, talar first metatarsal angle （TMT） on the lateral weight-bearing radiograph of foot, and the talocalcaneal angle （TC）, talar first metatarsal angle （TMT） on the AP view of the weight-bearing radiograph of foot, and the heel valgus alignment on axial radiographs of the hindfoot were measured on the X-ray film. Results All patients were followed up for 12 to 31 months, with the average of 16.8 months. Eleven pa- tients （13 feet） felt no pain 6 months after operation, while 2（3 feet） felt pain after long walking. There was no complication, including infection, nerve injury, un-union, and so on. The average AOFAS ankle-hindfoot score improved from 56.4±6.4 preoperatively to 88.1±2.8 at the last follow-up. Radio graphically, all param- eters were statistically significant between pre-operation and the last follow-up, including the arch height, CI, TC, TMT modifying from 3.8±0.3 mm, 9.5±1.1°, 47.30°± 2.5°, 17.6°±1.6° to 12.0~1.1 mm, 20.1°±1.5°, 32.3°±2.5°, 6.8°±1.0° respectively on the lateral weight-bearing view; TC improving from 39.50±2.3° to 26.2°±2.0°and TMT improving from 15.2°±1.7° to 6.3°±1.0°on the AP weight-bearing view. Conclusion The medial displacement ealeaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular with excellent clinical outcomes.