HyProCure跗骨螺钉治疗成年人柔韧性扁平足早期疗效分析

Application of HyProCure sinus tarsi stent for adult flexible flatfoot

背景：成人柔韧性扁平足的有效治疗方法目前仍存在争议。距跗关节稳定机制这一概念的提出和HyProCure跗骨螺钉的发明，给成人柔韧性扁平足治疗带来了新的理念和方法。目的：评价HyProCure跗骨螺钉治疗成年人柔韧性扁平足的早期临床疗效。方法：2012年9月至2013年3月，对27例（34足）成人柔韧性扁平足患者采用HyProCure跗骨螺钉实施距下关节稳定术治疗。男20例，女7例，年龄18-77岁，平均（33．8±11．6）岁。术后定期随访，随访内容包括临床并发症评估、x线和CT检查及基于PACS5．0系统的图像测量，并采用美国足踝外科协会（American Orthopedic Foot and Ankle Society,AO—FAS）踝与后足功能评分和视觉模拟评分（visual analogue score，VAS）进行术后疗效评定。结果：所有患者均获随访，随访时间3-6个月，平均（4．7±1．8）个月。除1例术后1个月因HyProCure脱出跗骨窦行更换手术外，余无明显围手术期并发症发生。随访期间无一例永久移除HyProCure。手术前后距骨第1跖骨角（14．1°±6．0°vs 4．7°±2．8°，P〈0．01）、跟骨倾斜角（16．1°±2．0°VS20．4°±2．2°，P〈0．05）、距舟覆盖角（24．9°±3．3°vs15．0°士2．1°，P〈0．01）和距骨第2跖骨角（32．3°±4．2°VS14．6。土1．9。，P〈0．01）改善明显，患足内侧纵弓高度显著提升（P〈0．01），VAS疼痛评分明显改善（P〈0．05），术后AOFAS踝与后足功能评分较术前提高了74．9％（44．2±11．1w77．3±10．7，P〈0．01）。结论：采用HyProCure跗骨螺钉治疗成年人柔韧性扁平足可以有效恢复正常足部骨性结构关系、手术创伤小、术后可早期负重、患足疼痛改善明显、功能提高显著，但远期疗效仍需进一步观察。

Background： Treatment of the adult flexible flatfoot （stage II adult acquired flatfoot deformity [AAFD]） is still controver- sial. Recently, the development of talotarsal joint stabilization and HyProCure device gives a new viewpoint in treating this disease. Objective： To evaluate the early clinical outcomes of adult flexible flatfoot treated with HyProCure sinus tarsi stent. Methods： From September 2012 to March 2013, 27 adult patients （34 feet） with flexible flatfoot underwent an extraosseous talotarsal stabilization （EOTTS） with the HyProCure device; There were 20 men and 7 women with an average age of （33.8±11.6） years （range, 18-77 years）. Complications were assessed, and X-ray and CT examination and image measure- ment based on PACS 5.0 system were performed during follow-up. The American Orthopedic Foot and Ankle Society （AO- FAS） ankle-hindfoot score and visual analog scale （VAS） score were used in the assessment of foot fimction and pre- and post-operative pain. Results： Average duration of follow-up was （4.7±1.8） months （range, 3-6 months）. The implant was replaced in 1 out of 34 feet at 1 month postoperatively because of dislocation. No severe perioperative complications occurred and no permanent de- vice removal was recorded during the follow-up period. Compared with preoperative angles, postoperative talar-to-first meta- tarsal angle, talonavicular coverage angle and talar-to-second metatarsal angle were significantly deceased （14.1°±6.0° vs 4.7°±2.8°, 24.9°±3.3° vs 15.0°±2.1°, 32.3°±4.2° vs 14.6°±1.9°, P〈0.01）, calcaneal pitch angle was significantly inceased （16.1°±2.0° vs 20.4°±2.2°, P〈0.05）. There was a substantial improvement in the medial longitudinal arch height and pain amelioration （P〈0.01）. AOFAS ankle-hindfoot score was increase by 74.9% after surgery （44.2°±11.1° vs 77.3°±10.7°, P〈0.01）.Conclusions： For adult flexible flatfoot, EOTTS with the HyProCure device can effectively restore the normal foot angular relationships, provide satisfactory results with minimal complications, early postoperative weight-bearing and obvious im- provement of foot function and pain amelioration. But the long-term curative effect still needs further observation.