内镜下跟骨成形术治疗Haglund畸形引起的后跟痛

ENDOSCOPIC CALCANEOPLASTY FOR Haglund's DEFORMITY WITH HINDFOOT PAIN

目的通过与保守治疗比较,探讨关节镜下跟骨成形术（endoscopic calcaneoplasty,ECP）治疗Haglund畸形所致后跟痛的疗效。方法 2007年1月-2013年10月,共64例（77足）Haglund畸形所致后跟痛患者符合选择标准,纳入研究。其中25例（28足）有运动要求以及规律运动习惯患者行ECP（ECP组）,39例（49足）无运动习惯患者行保守治疗（保守治疗组）。两组患者性别、年龄、侧别、病程、Fowler-Philip角及治疗前美国矫形足踝协会（AOFAS）踝-后足评分等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。结果两组患者均获随访,其中ECP组随访时间16-44个月,平均33.7个月;保守治疗组12-40个月,平均37.5个月。保守治疗组：34例（43足）经2周治疗后后跟肿胀、压痛消失;5例（6足）压痛仍存在,支具制动延长至3周后压痛消失;24例（30足）患者随访期间复发,其中11例（13足）于1年后选择ECP治疗。ECP组：患者术后切口均Ⅰ期愈合,无感染及神经血管损伤等并发症发生;随访期间无后跟肿胀及压痛。治疗后两组AOFAS踝-后足评分均较治疗前明显提高（P〈0.05）;但随时间延长,保守治疗组评分逐渐下降,而ECP组评分逐渐提高。ECP组治疗后各时间点AOFAS踝-后足评分明显高于保守治疗组（P〈0.05）。治疗后12个月,根据Ogilvie-Harris评分系统,ECP组获优9例,良12例,不满意4例,优良率为84.00%;保守治疗组获优8例,良14例,不满意17例,优良率为56.41%;两组比较差异有统计学意义（Z=—2.194,P=0.028）。结论在严格掌握手术适应证前提下,应用ECP治疗Haglund畸形引起的后跟痛具有良好疗效。

Objective To analyze the effectiveness of endoscopic calcaneoplasty（ECP） for treating hindfoot pain in patients with Haglund＇s deformity by comparing with conservative treatment. Methods According to the included standard, 64 hindfoot pain patients（77 feet） with Haglund＇s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient＇s sports habit, 39 patients（49 feet） who had no requirement on sports were given conservative treatment（control group） and 25 patients（28 feet） who had stable sports habit were given ECP（ECP group）. There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society（AOFAS） ankle-hindfoot score between 2 groups（P〉0.05）. Results The patients were followed up 16-44 months（mean, 33.7 months） in ECP group, and 12-40 months（mean, 37.5 months） in control group. In control group, the syndrome in 34 cases（43 feet） disappeared after 2 weeks; pain was improved in 5 cases（6 feet）, and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases（30 feet） during following-up, 11 cases（13 feet） underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment（P〈0.05）. With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment（P〈0.05）. According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups（Z= —2.194, P=0.028）. Conclusion Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund＇s deformity.