距舟楔关节融合结合自体髂骨植骨治疗Müller-Weiss病的临床研究

A clinical research of talonavicular-cuneiform arthrodesis combined with autologous iliac crest graft in the treatment of Müller-Weiss disease

目的探讨距舟楔关节融合治疗Müller-Weiss病的临床疗效。方法回顾性分析2012年1月至2015年11月于我院行距舟楔关节融合治疗的Müller-Weiss病患者19例,22足的术前及术后资料。患者术中在足内侧柱得到复位重建后,凿除舟骨外侧部分并进行清理,取适当大小的髂骨骨块进行植骨,足背侧进行锁定钢板固定,轴向予空心螺钉固定。术前及术后的疼痛模拟评分(visual analog scale,VAS评分)和美国矫形外科足踝协会踝与后足评分(American Orthopaedic Foot and Ankle Society,AOFAS评分)进行比较。结果所有患者均获得随访,平均随访时间为28个月(13~57个月),平均融合时间为15周(13~17周),4例严重的跟骰关节炎患者行骨赘清理手术,1例患者术后15个月时出现螺钉松脱,予内固定拆除。术后疼痛模拟评分及AOFAS评分均较术前明显改善(P=0.000)。结论距舟楔关节融合结合自体髂骨取骨植骨治疗Müller Weiss病疗效可靠,足内侧柱的复位重建对于恢复足部的解剖形态及术后功能具有重要意义。

Objective To investigate the clinical effect of talonavicular-cuneiform arthrodesis combined with autologous iliac crest graft in the treatment of Müller-Weiss disease.Methods From Janury 2012 and November 2015,19 patients,22 feet diagnosed as Müller-Weiss disease were treated with talonavicular-cuneiform arthrodesis combined with autologous iliac crest graft.The preoperative and postoperative data were retrospectively analyzed.After the corrected medial longitudinal arch reconstruction was achieved,the lateral necrotic lesion of the navicular bone was excised to form a bone bed.An appropriate autogenous bone graft harvested from the ipsilateral iliac crest was inserted into the space.Finally,cannulated screws and a dorsal locking compression plate(LCP)were used to arthrodese the talonavicular-cuneiform joints.Preoperative and postoperative visual analog scale(VAS)score and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society(AOFAS)were investigated.Results All patients were followed up with the average time 28 months(13-57 months)and the average arthrodesis times were 15 weeks(13-17 weeks).4 debridements were performed in severe calcaneocuboid arthritis,and one patient suffered from screw loosening at 15 months after operation and was dismantled with internal fixation.The postoperative VAS and AOFAS were significantly improved(P=0.000).Conclusion Talonavicular-cuneiform arthrodesis using an autologous iliac crest graft fixed by LCP and screws is a satisfactory treatment for the management of MWD.Reconstruction of medial column of foot is of great significance for restoring anatomical shape and function of foot after operation.