足舟骨切除并自体髂骨内侧柱重建治疗Müller-Weiss病

Excision of navicular and reconstruction of the medial column of foot with autogenous iliac graft for treatment of Müller-Weiss disease

[目的]介绍足舟骨切除并自体髂骨内侧柱重建治疗Müller-Weiss病的手术技术。[方法] 2012年4月～2017年3月,收集采用足舟骨切除并自体髂骨内侧柱重建治疗Müller-Weiss病9例(11足),女性7例,男性2例;年龄50～67岁。术中显露距舟关节,切除坏死舟骨,截除楔骨近端及距骨关节面软骨,以2.0 mm克氏针自软骨下骨钻孔使创面新鲜化,取楔形带三面骨皮质自体髂骨嵌入,2块钛板固定。[结果]所有病例均未出现伤口感染和血管神经损伤等并发症。9例患者均获得随访,随访时间15～72个月,与术前比,术后3个月及随访15个月的VAS评分均明显降低(P<0.05),AOFAS、Meary角和距跟角明显增大(P<0.05), 1例随访72个月内固定螺钉断裂。[结论]足舟骨切除并自体髂骨内侧柱重建术是一种安全、有效的治疗Müller-Weiss病的方法,适用于Maceira分期4和5期患者。

[Objective] To introduce operative technique of excision of navicular and reconstruction of the medial column of foot with autogenous iliac graft for the Müller-Weiss disease.[Methods] From April 2012 to March 2018, 9 patients(11 feet),including 7 females and 2 males aged 50~67 years, underwent surgical treatment for Müller-Weiss disease. During operation,the talonavicular joint was exposed, and then the navicular was totally removed, accompanied with removing the articular cartilage on the proximal talus and distal cuneiforms that were refreshed by microfracture with Kirschner wire 2.0 mm in diameter, a tricortical bone block harvested from iliac crest was inserted into the defect and fixed with 2 plates.[Results] No serious complication, such as neurovascular injuries and incision infection, happened in anyone of them. All the 9 patients were followed up for 15~72 months. Compared with those before surgery, the VAS scores significantly decreased(P<0.05), whereas the AOFAS, Meary angle and talocalcaneal angle significantly increased at 3 and 15 months after operation(P<0.05). At 72 months postoperatively 1 patient had screw broken.[Conclusion] Excision of navicular and reconstruction of the medial column of foot with autogenous iliac graft is a safe and effective treatment for Müller-Weiss disease, which is suitable for Maceira stage IV and V.