跟骨Z形截骨治疗柔韧性扁平足

Calcaneal Z osteotomy in the treatment of flexible flatfoot

目的探讨跟骨Z形截骨术治疗扁平足的可行性、有效性。方法回顾性分析2011年10月至2014年12月,瑞金医院采用跟骨Z形截骨治疗的柔软性扁平足患者资料,分别测量及分析其术前、术后后足外翻角、距舟覆盖角、侧位第一跖距角、距骨倾斜角等角度变化,采用美国足踝医师协会踝-后足评分（AOFAS-AH）比较患者术前术后功能变化情况。结果 18例均获12-28个月随访,平均17.6个月。后足外翻角：术前（12.9±5.5）°,术后（2.0±2.8）°,P=0.0001,差异有统计学意义。距舟覆盖角：术前（24.4±11.0）°,术后（11.3±8.8）°,P=0.0002,差异有统计学意义。侧位片第一跖距角：术前（17.1±6.4）°,术后（3.3±3.6）°,P〈0.0001,差异有统计学意义。距骨倾斜角：术前（32.4±5.7）°,术后（23.0±3.7）°,P=0.0007,差异有统计学意义。AOFAS评分：术前（58.2±17.5）分,术后（95.0±4.4）分,P=0.0002,差异有统计学意义。结论跟骨Z形截骨是治疗扁平足的有效方式,可改善患者症状、恢复足的正常排列,但此手术开展较少,长期疗效有待进一步观察。

Objective To explore the effect of calcaneal Z osteotomy in treatment of fl exible fl atfoot. Methods Retrospective analysis was conducted for 18 patients with fl exible fl atfoot treated with calcaneal Z osteotomy in Ruijin Hospital from October 2011 to December 2014. We measured the hindfoot valgus angles, talar decline angles and talarfi rst metatarsal angles on lateral fi lms and so on to compare the condition after surgery and before surgery. The AOFASAH score was adopted to evaluate the preoperative and postoperative status. Results All patients were followed up for an average of 17.6 months（ range, 12 to 28 months）. The preoperative hindfoot valgus angle, talar coverage angle, talo-first metatarsal angle in lateral view, talar decline angle and AOFAS-AH score were（ 12.9 ± 5.5） °,（ 24.4 ± 11.0） °,（ 17.1 ± 6.4） °,（ 32.4 ± 5.7） ° and（ 58.2 ± 17.5）. The postoperative hindfoot valgus angle,, talar coverage angle, talo-fi rst metatarsal angle in lateral view, talar decline angle and AOFAS-AH scores were（ 2.0 ± 2.8） °,（ 11.3 ± 8.8） °,（ 3.3 ± 3.6） °,（ 23.0 ± 3.7） ° and（ 95.0 ± 4.4）. The differences were statistically sigfi nicant（ P = 0.0002）. Conclusions Calcaneal Z osteotomy is a sound method to deal with the fl exible fl atfoot. The procedure can relieve pain of patients and get normal alignment of foot. But it is worthy of further study because of insufi cient practice.