趾长屈肌腱或足拇长屈肌腱转位并跟骨内移截骨术治疗Myerson ⅡA期平足症

Flexor digitorum longus tendon transfer or flexor hallucis longus tendon transfer with medial displacement calcaneal osteotomy for treatment of Myerson stage ⅡA flatfoot

目的探讨趾长屈肌腱或足拇长屈肌腱转位并跟骨内移截骨术治疗MyersonⅡA期平足症的疗效。方法纳入自2013-06—2016-06诊治的25例MyersonⅡA期平足症,其中14例行趾长屈肌腱转位并跟骨内移截骨术,11例行足拇长屈肌腱转位并跟骨内移截骨术。比较术前及末次随访时侧位跟距角、前后位跟距角、侧位第1跖距角、跟骨倾角、距骨覆盖角,以及踝关节功能AOFAS评分。结果 25例均获得随访,随访时间平均9.5(6～22)个月。24例对疗效感到满意,负重行走时足和踝部疲劳及疼痛感消失,穿鞋受限感消失;1例行足拇长屈肌腱转位者久行或跑步后感觉足部隐痛不适。末次随访时患者侧位跟距角、前后位跟距角、侧位第1跖距角、跟骨倾角、距骨覆盖角、踝关节功能AOFAS评分较术前明显改善,差异有统计学意义(P <0.05)。结论趾长屈肌腱与足拇长屈肌腱转位并跟骨内移截骨术治疗MyersonⅡA期平足症可取得较为满意的疗效,可明显缓解患足疼痛,改善患足功能,并且有效矫正跟骨畸形。

Objective To analyze the clinical outcomes of the flexor digitorum longus tendon transfer or flexor hallucis longus tendon transfer with the medial displacement calcaneal osteotomy for the treatment of Myerson stage II A flatfoot. Methods Twenty-five patients with Myerson stage IIA flatfoot were treated from June 2013 to June 2016. Among them, 14 patients were treated with the flexor digitorum longus tendon transfer with the medial displacement calcaneal osteotomy, while II patients were treated with the flexor hallucis longus tendon transfer with the medial displacement calcaneal osteotomy. The AOFAS score and the specific index of X-ray including the lateral talocal caneal angle, the AP talocal caneal angle, the lateral talar-lst metatarasl angle, the calcaneal inclination angle, the talonavieular coverage angle were compared before and after the operation. Results All patients were followed up 6 to 22 months with an average of 9.5 months. Twenty-four patients were satisfied with the effect. Fatigue and pain of feet and ankle disappeared while walking with weight, and the limited feeling of wearing shoes disappeared. One patient who treated with the flexor hallucis longus tendon transfer felt feet pain and discomfort after running or walking for a long time. The lateral talocal caneal angle,the AP talocal caneal angle, the lateral talar-lst metatarasl angle, the calcaneal inclination angle, the talonavicular coverage angle and AOFAS score improved significantly at the final follow up visit compared with those before operation （P 〈0.05）. Conclusion The flexor digitorum longus tendon transfer or flexor hallucis longus tendon transfer with the medial displacement calcaneal osteotomy for the treatment of Myerson stage II A flatfoot has excellent effectiveness, can significantly relieve pain, improve foot function and correct foot deformity.