跟舟联合切除及趾短伸肌肌瓣置入手术治疗症状性跟舟联合的疗效分析

Analysis of the surgical efficacy of calcaneonavicular coalition resection with extensor digitorum brevis interposition in the symptomatic calcaneonavicular coalition

目的探讨症状性跟舟联合患者跟舟联合切除及趾短伸肌肌瓣置入的手术疗效。方法回顾性分析2016年2月—2018年3月北京同仁医院足踝外科9例(10足)症状性跟舟联合患者的临床资料。其中男6例、女3例,年龄11~63(平均30.3)岁,骨性联合2足、纤维性联合8足。患者均行跟舟联合切除及趾短伸肌肌瓣置入手术治疗,术后观察有无出现伤口感染、术区疼痛、跟舟联合复发、周围关节退变及足部畸形,比较患者手术前后疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分。结果 9例患者随访17~42个月,平均29.1个月。所有患者症状缓解,未出现伤口感染、复发、周围关节退变及后足力线异常。患者末次随访疼痛VAS为(1.50±0.97)分,较术前(4.30±1.49)分明显降低,差值3(2,3)分,差异有统计学意义(Z=2.859,P<0.01);末次随访AOFAS评分为(90.40±7.04)分,较术前(77.30±7.66)分明显提高,差值(13.10±5.70)分,差异有统计学意义(t=7.262,P<0.01)。所有患者对治疗结果表示满意。结论对于症状性跟舟联合患者,保守治疗失败时可行手术治疗,跟舟联合切除后用趾短伸肌肌瓣置入可有效预防跟舟联合的复发,临床疗效肯定。

Objective To evaluate the surgical efficacy of coalition resection with extensor digitorum brevis interposition in symptomatic patients with calcaneonavicular coalition.Methods Retrospective study.A total of 9 patients(10 feet)with symptomatic calcaneonavicular coalition were included in the Department of Foot and Ankle Surgery of Beijing Tongren Hospital from February 2016 to March 2018,who underwent calcaneonavicular coalition resection with extensor digitorum brevis interposition,which consisted of 6 males and 3 females with a mean age of 30.3(range,11-63)years.Two feet were osseous coalition and the others(8 feet)were fibrous coalition.Observation of surgical effect included:wound infection,pain,coalition recurrence,adjacent joint degeneration,and foot deformities.The visual analogue scale(VAS)and American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score were evaluated preoperatively and postoperatively.Results The 9 patients were followed up for 17-42 months,the mean followed-up time was 29.1 months.All patients showed remission of symptoms,no wound infection,coalition recurrence,adjacent joint degeneration or abnormal posterior foot strength line occured.Postoperative VAS(1.50±0.97)at the last follow-up was obviously lower than preoperative VAS(4.30±1.49),with a difference of 3(2,3),indicating a statistically significant difference(Z=2.859,P<0.01).Postoperative AOFAS score at the last follow-up(90.40±7.04)was obviously higher than preoperative AOFAS score(77.30±7.66),with a difference of(13.10±5.70),indicating a statistically significant difference(t=7.262,P<0.01).All patients were satisfied with the treatment results.Conclusions For symptomatic calcaneonavicular coalition patients,surgical treatment is feasible when conservative treatment fails.After calcaneonavicular coalition resection,extensor digitorum brevis interposition can prevent coalition recurrence and acquire positive surgical efficacy.