单独内侧切口的后足双关节融合术治疗平足症

DOUBLE ARTHRODESIS THROUGH A SINGLE MEDIAL INCISION APPROACH FOR FLATFOOT

目的 探讨单独内侧切口的后足双关节融合术治疗伴后足外翻的平足症临床疗效。方法 2009年5月-2012年5月,采用单独内侧切口的距下关节和距舟关节双关节融合术治疗伴后足外翻的平足症12例。其中男5例,女7例;年龄21～78岁,平均53.3岁。左足5例,右足7例。其中11例胫后肌腱功能不全,Johnson-StromⅢ期6例,Ⅱ（c）期5例;1例跗骨联合。采用美国矫形足踝协会（AOFAS）踝-后足评分为（48.75±3.46）分;疼痛视觉模拟评分（VAS）为（6.08±1.14）分。结果 手术时间65～125 min,平均85.6 min。术后切口均Ⅰ期愈合,无感染及内侧神经、血管损伤等并发症发生。11例患者获随访,随访时间13～30个月,平均19.4个月。X线片复查示,骨愈合时间7～18周,平均9.8周;无骨不连发生;均无内固定物松动、断裂等并发症发生。术后发生跟骰关节疼痛和内固定疼痛各1例,经对症处理后疼痛消失。患者术后足部外形均获明显改善。末次随访时VAS评分为（0.72±0.11）分,与术前比较差异有统计学意义（t=16.288,P=0.000）;AOFAS踝-后足评分为（81.36±2.98）分,与术前比较差异有统计学意义（t=19.946,P=0.000）。结论 单独内侧切口行距下关节和距舟关节融合术能有效矫正后足畸形,对于平足症是一种有效替代三关节融合术的术式。

Objective To investigate the efectiveness of double arthrodesis to correct flatfoot deformity with pesvalgus. Methods Between May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated usingsubtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years （range, 21-78 years）, including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stage III, 5 cases at stage II（c）; and 1 case had tarsal coalition. Preoperative American Orthopaedic Foot and Ankle Society （AOFAS） score and visual analogue scale （VAS） score were 48.75 ± 3.46 and 6.08 ± 1.14, respectively. Results The mean operation time was 85.6 minutes （range, 65-125 minutes）. Eleven patients were followed up for 19.4 months on average （range, 13-30 months）. All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks （range, 7-18 weeks）;no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint （1 case） and at fixation site （1 case）, and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36 ± 2.98 and 0.72 ± 0.11 respectively, showing significant diff erences when compared with preoperative scores （t=19.946, P=0.000; t=16.288, P=0.000）. Conclusion Subtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to triple arthrodesis for the correction of flatfoot deformity with pes valgus.