距下关节稳定术治疗儿童柔韧性平足症

Treatment of extraosseous talotarsal stabilization for flexible flatfoot in children

目的评价利用HyProCure距下关节稳定器治疗儿童柔韧性平足症的临床疗效。方法回顾性分析2015年3月至2018年3月南部战区总医院收治的12例(18足)应用HyProCure距下关节稳定器施行距下关节稳定术(EOTTS)的柔韧性平足症患儿的临床资料,评估患者术后足部疼痛、功能及影像学指标改善情况。结果患儿均获得随访,随访时间9~18个月,平均随访时间(11.6±3.2)个月。随访期间无1例内植物移除。术前和术后6个月随访时疼痛视觉模拟量表(VAS)评分、美国矫形外科足踝协会(AOFAS)踝与后足功能评分分别为(4.5±1.0)、(1.5±0.8)分和(57.8±5.6)、(86.5±5.8)分,手术前后比较,差异均有统计学意义(P<0.05);距骨第一跖骨角、跟骨上倾角、距舟覆盖角分别由术前的(–7.5±1.2)°、(8.8±1.0)°、(22.8±1.8)°改善为术后6个月的(0.4±1.5)°、(13.5±1.1)°、(16.0±1.5)°,手术前后比较,差异有统计学意义(P<0.05)。结论EOTTS治疗儿童柔韧性平足症早期疗效良好,具有微创、并发症少等优点。

Objective To evaluate the clinical efficacy of HyProCure talotarsal stabilization device in treatment of flexible flatfoot in children.Methods Clinical data of 12 children(18 foot)with flexible flat feet who treated by extraosseous talotarsal stabilization(EOTTS)with HyProCure stabilizer from March 2015 to March 2018 in General Hospital of Southern Theatre Command,were retrospectively analyzed.Improvement of patients’feet pain and functions,as well as foot imaging parameters were evaluated after the surgery.Results All patients were followed up for 9 to 18 months,with an average follow-up time of(11.6±3.2)months.No implants were removed during the follow-up.Before the surgery and at 6 months’follow-up postoperatively,pain visual analogue scale(VAS)score,ankle and hind foot function score of American Orthopaedic Foot and Ankle Society(AOFAS)were(4.5±1.0)and(1.5±0.8),(57.8±5.6)and(86.5±5.8)respectively,the differences between preoperation and postoperation had statistical significance(P<0.05).Meary’s angle,calcaneal pitch angle and talonavicular coverage angle improved from the degree of(–7.5±1.2),(8.8±1.0),(22.8±1.8)before the surgery to the degree of(0.4±1.5),(13.5±1.1),(16.0±1.5)at 6 months’follow-up after the surgery respectively(P<0.05).Conclusion EOTTS has good early curative effect on children with flexible flat feet,and has the advantages of minimally invasive procedure and fewer complications.