骨桥切除治疗成人非关节炎性跟距骨桥的疗效观察

Osseous bridge resection for the treatment of adult talocalaneal coalitions without arthritis

目的 :探讨骨桥单纯切除治疗成人非关节炎性跟距骨桥的临床疗效。方法 :回顾分析2013年1月至2016年6月手术治疗的12例(15足)非关节炎性跟距骨桥成人患者的临床资料。患者均为继发性骨桥,其中男9例(11足),女3例(4足);年龄18~33岁,平均(26.6±3.3)岁。根据Rozansky分型:Ⅰ型4例(6足),Ⅱ型3例(3足),Ⅲ型2例(2足),Ⅳ型1例(1足),Ⅴ型2例(3足)。记录术后并发症、复发及关节活动度改善情况,并采用疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝与后足功能评分评价临床疗效。结果:12例患者均获随访,时间12~48个月,平均(28.7±18.3)个月。术后切口均Ⅰ期愈合,术后无感染或皮肤坏死、血管神经及肌腱损伤发生。术后13足关节活动度较术前改善。所有患者术后均重返工作岗位。1例术后2年复发,再次行骨桥切除。术后1年VAS评分2.1±0.8与术前8.2±0.7比较差异有统计学意义(t=6.233,P<0.01),术后1年AOFAS评分82.7±7.2,与术前48.4±6.8比较差异有统计学意义(t=5.747,P<0.01),其中优1例,良10例,可1例。结论:对于非关节炎性跟距骨桥成人患者,骨桥切除可以有效缓解疼痛,改善关节活动度,临床疗效满意。

Objective：To analyze clinical outcomes of osseous bridge resection for the treatment of adult symptomatic talocalcaneal coalitions without arthritis. Methods：The clinical data of 12 patients（15 feet） with symptomatic talocalcaneal coalitions without arthtitis from January 2013 to June 2016 were respectively analyzed. All cases were secondary talocalcaneal coalition. There were 9 males（11 feet） and 3 females（4 feet） with a mean（26.6±3.3） years old（ranged,18 to 33 years old）.According to the Rozansky classification,there were 4（6 feet） typeⅠ,3（3 feet） typeⅡ,2（2 feet） type Ⅲ,1（1 feet） typeⅣ,and 2（3 feet） type Ⅴ. All patients received coalition resection and interposition of fat graft. Complication,recurrence and range of motion was regularly recorded after operation. Clinical efficacy was evaluated according to the visual analogue scale（VAS） and the American Orthopedic Foot and Ankle Society（AOFAS） ankle hindfoot scale. Results：All patients were followed up for an average duration of（28.7±18.3） months（ranged,12 to 48 months）. All the incisions were primarily healed.There were no wound necrosis,infection,neurovascular or tendon injuries. Range of motion was improved in 13 feet. All patients returned back to work. Recurrence happened in 1 case 2 years after surgery,the patient received a secondary coalition resection. At the latest follow up,VAS was 2.1±0.8 and AOFAS score was 82.7±7.2,were siginificantly improved when compared with the preoperative scores（8.2±0.7,t=6.233,P〈0.01;48.4±6.8,t=5.747,P〈0.01）. Conclusion：For adult patients with symptomatic talocalcaneal coalitions without arthritis,simple coalition resection could provide good clinical outcomes with minimal complications.