单纯内侧入路距下关节融合治疗平足症的效果

Curative effect of subtalar joint arthrodesis for flatfoot deformity

背景：平足症是足踝外科的常见病,目前治疗方法众多,但缺乏机制认识和同一观点,传统治疗方法大多会使足部处于非生理状态。目的：探讨单纯距下关节融合治疗平足症的手术方法和临床疗效。方法：2011年3月至2014年3月,使用单纯距下关节融合方法治疗平足症14例,男3例,女11例,年龄51~75岁,平均60.81岁。所有患者均为胫后肌腱功能不全,Myerson分型：Ⅱa 9例、Ⅱb 3例、Ⅱc 2例。回顾分析患者术前、术后及随访时的病例资料。结果：所有患者手术时间91~124 min,平均100.54 min。其中12例患者获得随访,随访时间12~48个月,平均20.25个月。手术切口均甲级愈合,未发现感染。骨愈合时间8~17周,平均9.53周。1例患者随访时出现内固定疼痛。无骨不连或者内侧神经血管损伤情况发生。AOFAS评分从术前的43.67分提高至末次随访时的80.81分。VAS疼痛评分从术前的6.67分降至末次随访时的0.66分。结论：对于轻度或部分中度平足症畸形,单纯距下关节融合可获得良好的临床效果。

Background：Flatfoot is a common foot deformity. Its pathogenesis is not clear and the treatment is still controversial. Most of traditional treatments make the foot in a non-physiological state. Objective：To explore surgical techniques and clinical outcome flatfoot deformity corrected by subtalar joint arthrodesis. Methods： Fourteen patients with flatfoot deformity treated by subtalar joint arthrodesis from March 2011 to March 2014 were enrolled in this study. There were 3 males and 11 females with an average age of 60.81 years （ranged from 51 to 75 years）. Posterior tibial tendon dysfunctions were found in all patients. Of them, there were 9 cases of Myerson typeⅡa, 3 ofⅡb and 2 ofⅡc. The preoperative and postoperative data were retrospectively analyzed. Results：The mean operation time was 100.54 min （range, 91-124 min）. Twelve patients were followed up for 20.25 months on average （range, 12-48 months）. All of the cases have healed well, and the mean time of bone union was 9.53 weeks （ranged from 8 to 17 weeks）. No infection was found in any cases. Painful fixation was observed in one patient. None of the patients experienced a nonunion or an adverse event related to the medial neurovascular structures. The mean AOFAS score increased from 43.67 preoperatively to 80.81 at the last follow-up, while the VAS score decreased from 6.67 preoperatively to 0.66 at the last follow-up. Conclusions：Based on our experience with the procedure, subtalar joint arthrodesis is a useful alternative to triple arthrode-sis for the correction of mild and some moderate flatfoot deformity.