HyProCure距下关节稳定器治疗青年士兵柔韧性扁平足早期疗效分析

Effect of HyProCure talotarsal stabilization device on flexible flatfoot among young soldiers

目的观察HyProCure距下关节稳定器治疗青年士兵柔韧性扁平足的早期临床疗效。方法2012年9月—2013年3月，采用HyProCure距下关节稳定器对13例（15足）诊断为柔韧性扁平足的士兵实施距下关节稳定术。术后对围术期并发症、影像学角度测量进行随访，并采用Maryland足部评分标准进行术后疗效评定。结果经随访3—6（4．3±1．4）个月，无明显围术期并发症发生。随访期间无一例永久移除HyProCure距下关节稳定器。手术前、后距骨第1跖骨角[（13．7±5．8）°、（4．9±2．6）°（P〈0．01）]、跟骨倾斜角[（16．7±1．8）°、（20．1±2．4）°（P〈0．05）]以及距舟覆盖角[（24．2±3．0）°、（15．4喜2、3）。（P〈0．01）]明显改善，内侧纵弓高度显著提升（P〈0．01），术后Maryland足部评分较术前提高了65．7％[（49．3±7．4）、（81．7±9．6）、（P〈0．01）]。结论采用HyProCure距下关节稳定器治疗青年士兵柔韧性扁平足可有效纠正足部结构异常，具有手术创伤小、术后负重早且足功能改善显著等特点。但远期疗效仍有待进一步评价。

Objective To assess the early clinical and radiographic outcome of flexible flatfoot among young soldiers treated with HyProCure talotarsal stabilization device. Methods From September 2012 to March 2013, a total of 13 feet （ 15 young soldiers） with flexible/reducible flatfoot underwent an extraosseous talotarsal stabilization （EOTTS） surgery with HyProCure device. The follow-up evaluation included perioperative complications and radiographic measurement. The Maryland foot rating score was used in the assessment of postoperative performance. Results Average duration of follow-up was 3 - 6 （4.3 ± 1.4） months. No obvious perioperative complications occurred and no permanent device removal was recorded during the follow-up period. The EOTTS procedure allowed the mean preoperative., talar-to-first metatarsal angle of （ 13.7 ± 5.8 ） ° , calcaneal pitch angle of （ 16.7 ± 1. 8 ） ° and talonavicular uncoveratze angle of,（24.2 ±3.0）° to be improved to （4.9 ±2.6）°（20.1 ±2.4）° and （15.4 ±2.3）° respectively（ P 〈 0.01 or P 〈 0.05 ）. There was a substantial improvement in the medial longitudinal arch height （ P 〈 0.01 ）. The mean preoperative Maryland foot rating score （49.3 ± 7.4） was improved up to postoperative 81.7 ±9.6, with a mean increase of 65.7 % （P 〈 0.01 ）. Conclusion For young soldiers diagnosed as flexible flatfoot, surgical correction with HyProCure EOTTS device can effectively correct the abnormal foot structure, with the characteristics of minimal complications, early postoperative weight-bearing and good foot function in the early stage. But the long-term curative effect still needs further observation.