副舟骨融合术治疗成人Ⅱ型痛性足副舟骨临床疗效分析

Outcome of accessory navicular fusion for the treatment of the painful accessory navicular bone of type Ⅱ in adults

目的：探讨副舟骨融合术治疗成年人Ⅱ型痛性足副舟骨的临床疗效.方法：2006年6月至2012年6月,采用副舟骨融合手术治疗35例（38足）成人Ⅱ型痛性足副舟骨患者,其中男26例,女9例;年龄18～44岁,平均（32.4±7.3）岁;病程3～10个月.记录患者围手术期并发症,测量影像学数据,并采用美国足踝外科协会AOFAS（American Orthopedic Foot and Ankle Society,AOFAS）评分对足功能进行评价,采用疼痛视觉模拟评分（visual analogue score,VAS）对疼痛缓解程度进行评价.结果：术后除2例发生切口浅表感染外,无明显围手术期并发症发生.35例患者全部获随访,时间12～84个月,平均（53.5±14.7）个月.32例（35足）患者达到影像学愈合,术后愈合时间9～18周,平均（13.7±2.3）周.VAS疼痛评分较术前明显改善（x2=12.14,P＜0.01）.手术前后距骨第1跖骨角[（9.4±3.5）°vs （8.3±2.7）°,t=0.736,P＞0.05],跟骨倾斜角[（17.7±2.2）°vs（18.9±3.4）°,t=0.794,P＞0.05],距舟覆盖角[（14.3±3.4）°vs （12.5±4.6）°,t=0.947,P＞0.05]及第1跖楔关节高度[（14.8±3.1）mmvs （15.9±2.8） mm,t=0.814,P＞0.05]比较差异无统计学意义.术后AOFAS评分较术前明显提高（45.6±5.3 vs 82.5±7.4,t=3.214,P＜0.01）.结论：对于保守治疗失败的成人Ⅱ型痛性足副舟骨,当副舟骨骨块较大,不伴有僵硬性扁平足时,副舟骨融合术可以有效缓解疼痛症状,提高患足功能,术后患者满意度高,手术疗效确实.

Objective：To evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type Ⅱ in adults.Methods：From June 2006 to June 2012,a total of 38 feet （in 35 adult patients） with painful accessory navicular with type Ⅱ underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of （32.4±7.3） years old ranging from 18 to 44 years old.The course of disease ranged from 3 to 10 months.The perioperative complications and radiological outcomes were observed and recorded.The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society （AOFAS） midfoot score,and the easement of the pain was evaluated by visual analog score （VAS）.Results：Two patients had transient superficial inflammation of the incision,no obvious perioperative complications occurred.All patients were follow-up for （53.5±14.7） months （12 to 84 months）.Bone union was confirmed on plain radiography in 32 cases （35 feet）.The mean time from the operation to union was （13.7±2.3） weeks （9 to 18 weeks）.Postoperative pain VAS score was improved obviosly than preoperative （x2=12.14,P＜ 0.01）.The talar-to-first metatarsal angle [（9.4±3.5） ° vs （8.3±2.7） °,t=0.736,P＞0.05）],calcaneal tilt angle [（17.7±2.2） ° vs （18.9±3.4） °,t=0.794,P＞0.05],talonavicular uncoverage angle [（14.3±3.4） ° vs （12.5±4.6） °,t=0.947,P＞0.05）],and height of the first tarsometatarsal joint [（14.8±3.1） mm vs （15.9±2.8） mm,t=0.814,P＞0.05）] before and after operations had no statistic difference.The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 （t=3.214,P＜ 0.01）.Conclusion：For the painful accessory navicular bone of type Ⅱ in adults,if the patient has a large navicular bone and not complicated with rigid flatfoot,once the conservative treatment fails,fusion of the primary and accessory naviculars may be a successful intervention.Overall,the procedure provides reliable pain relief,definite foot function improvement,and good patient satisfaction.