锁定螺钉固定距下关节治疗平足症疗效观察

Curative effect of aided fixation of subtalar joint by locking screw on flatfoot

目的:探讨关节融合术治疗平足症应用锁定螺钉辅助固定距下关节的疗效。方法:2012年4月至2016年3月在我院门诊收集14例成年人获得性平足症患者,采用内侧入路行距下及距舟关节截骨矫形融合治疗。距下关节后关节面应用空心螺钉固定,距舟关节则选用锁定钢板固定,同时在锁定钢板远端应用长度60~65 mm锁钉拧入跟骨远端辅助固定距下关节,术后将足置于功能位予以石膏固定4周后拆除,根据骨愈合情况逐渐开始负重训练。结果:全部病例均获得随访,随访时间6~14个月(平均9.6个月),随访期间所有患者均未出现断钉、退钉及假关节形成,且达到骨性愈合。结论:距舟关节锁定钢板远端锁钉辅助固定距下关节,可增加距下关节及距舟关节稳定性,促进骨质生长,降低骨不连的发生率。

Objective： To explore the efficacy of aided fixation of subtalar joint by locking screw in arthrodesis for flatfoot.Methods： From April 2012 to March 2016,14 cases of adult acquired flatfoot were collected in our outpatient department. They underwent subtalar joint and talonavicular joint osteotomy and fusion treatment through inside approach. The posterior articular facet of subtalar joint was fixed by hollow screw,and talonavicular joint was fixed by locking plate. And at the distal end of locking plate,the locking screw of 60-65 mm length was screwed into distal calcaneus for the aided fixation of subtalar joint.After operation,the treated foot was placed at the functional position and was fixed by plaster for 4 weeks. Weight training gradually started according to bone healing status. Results： All cases were followed up for 6-14 months with an average of 9. 6months. During the follow-up period,none of nail withdrawal,nail breakage and false joints was occurred,and all patients reached bony union. Conclusion： The aided fixation of subtalar joint by locking screw at the distal end of locking plate for talonavicular joint fixation can increase the stability of subtalar joint and talonavicular joint,promote the growth of bone,and reduce the incidence of nonunion.