改良Kidner手术联合HyProCure治疗副舟骨源性平足症疗效观察

The Clinical Effect of Modified Kinder Surgery with HyProCure in Treatment of Flatfoot with Accessory Navicular

目的探讨改良Kidner手术联合HyProCure距下关节稳定器治疗副舟骨源性平足症的初期治疗效果。方法 2014年12月至2016年10月,收治副舟骨源性平足症患者17例(24足),均经过半年以上的保守治疗后疼痛症状无缓解,其中男6例(8足),女11例(16足);年龄11～17岁,平均13.5岁。美国矫形足踝协会(American orthopaedic foot and ankle society,AOFAS)踝与后足功能评分为(71.7±4.3)分,术前视觉模拟评分(visual analogue scale,VAS)为(5.54±0.93)分。术前检查为Ⅱ型副舟骨伴后足轻度外翻畸形,足弓高度有不同程度降低。术中均切除副舟骨,置入HyProCure距下关节稳定器,使用带线锚钉重建胫后肌腱。8例联合行经皮跟腱延长,7例联合行腓肠肌松解,5例同时行弹簧韧带紧缩。于侧位X线片上测量距骨第1跖骨角(Meary's角)、跟骨倾斜角(Pitch角),正位X线片上测量距舟覆盖角(talocal caneal angle,TCA)、距骨跟骨角(Kite角),采用AOFAS踝与后足功能评分及VAS评分评价临床疗效。结果术后17例(24足)患者均获随访,随访时间7～23个月,平均13.6个月。侧位X线片上的距骨第1跖骨角、跟骨倾斜角,正位X线片上的距舟覆盖角、距骨跟骨角均较术前改善,差异有统计学意义(P<0.05)。末次随访时AOFAS评分及VAS评分与术前比较明显改善,差异有统计学意义(P<0.05)。结论改良Kidner手术联合HyProCure距下关节稳定器治疗副舟骨源性平足症,能有效纠正平足畸形,恢复足部功能,并发症少,但远期疗效有待进一步随访。

Objective To evaluate the short-term effectiveness of modified Kinder surgical with HyProCure subtalar stabilization in treatment of flatfoot with accessory navicular.Methods Between December 2014 and Octobetr 2016,17 patients（24 feet）with flatfoot related with accessory navicular were treated,which received conservative treatment for more than half a year,but the pain symptoms were not relieved.There were 6 males（8 feet）and 11 females（16 feet）with the average age of 13.5 years（range,11～17 years）.The American Orthopaedic Foot and Ankle Society（AOFAS）ankle and foot function score was（71.7±4.3）,the preoperative pain visual analogue scale（VAS）was（5.54±0.93）.The preoperative examination showed typeⅡaccessory navicular,with posterior foot mild valgus deformity.The height of the arch was reduced in varying degrees.All of them received excision of accessory navicular,placement of HyProCure subtalar stabilization and reconstruction of posterior tibial tendon insertion on navicular with anchor.There were percutaneous Achilles tendon lengthening in 8 feet and gastrocnemius lysis in 7 feet and spring ligament tightening surgery in 5 feet.The talar-first metatarsal angle（Meary＇s angle）and calcaneus inclination angle（Pitch angle）were measured on the lateral X ray,and the talonavicular coverage angle（TCA）and talocalcaneal angle（Kite angle）were measured on the frontal,the AOFAS ankle and foot function score and VAS score were used to evaluate the effectiveness.Results Seventeen patients（24 feet）were followed up for 7 to 23 months with an average of 13.6 months.The talar first metatarsal angle and calcaneus inclination angle on the lateral X ray and the talonavicular coverage angle and talocalcaneal angle on the frontal were improved（P〈0.05）.Compared with preoperation,AOFAS ankle and foot function score and VAS score were significantly improved at last follow-up,the difference were statistically significant（P〈0.05）.Conclusion The modified Kinder surgical with HyProCure subtalar stabilization is a good choice for the treatment of flatfoot related with accessory navicular,which can effectively correct the flatfoot deformity,recover foot function and induce less complications,but the long-term effectiveness needs further follow-up.