副舟骨融合术治疗成人Ⅱ型痛性足副舟骨临床疗效分析

Analysis of the Clinical Effect of Parascaphoid Fusion in the Treatment of Adult TypeⅡPainful Foot Parascaphoid

目的分析成人Ⅱ型痛性足副舟骨患者行副舟骨融合术治疗的临床价值。方法纳入该院于2011年1月-2014年1月期间收治的,满足入组标准的35例(38足)成人Ⅱ型痛性足副舟骨患者作为研究对象,所有患者均实施副舟骨融合术治疗。记录手术前后临床结果、影像学、患足功能改善情况。结果 35例患者均成功随访,最长随访用时3年,最短随访用时1年,平均随访(53.4±14.6)月;4例患者手术后存在炎性状态,通过换药后痊愈,其余患者手术切口均愈合,无神经以及血管损伤并发症出现;手术后患者进行X线检查,32例(35足)患者影像学显示痊愈,术后愈合最长17周,最短8周,平均(13.69±2.31)周。3例(3足)术后存在螺钉松动以及融合失败反应,均在术后半年进行改良手术处理。手术前后测量指标对比,组间差异无统计学意义(t=1.298、1.266、0.743、1.268,P>0.05);手术后AOFAS足功能分值均高于术前,两组对比差异有统计学意义(t=14.924、6.723、5.363、23.940,P<0.05)。结论对行常规治疗无效、副舟骨骨块较大、未伴有僵硬性扁平足患者,通过副舟骨融合术处理有效改善疼痛反应,提升患侧肢体功能,术后具有较高满意度,手术效果显著。

Objective To analyze the clinical value of parascaphoid fusion in adult patients with type Ⅱ painful foot parascaphoid. Meth-ods 35 cases(38 feet) of adult type Ⅱ painful foot parascaphoid patients who were admitted to the hospital from January 2011 to Jan-uary 2014 and met the enrollment criteria were included as the research subjects. All patients were treated with parascaphoid bone fu-sion treatment. The clinical results, imaging studies, and improvement of the foot function before and after the operation were record-ed. Results All 35 patients were successfully followed up. The longest follow-up time was 3 years, and the shortest follow-up time was1 year. The average follow-up was(53.4±14.6) months;4 patients had an inflammatory state after surgery and were cured by dressing change. The remaining patients had surgical incisions Healed without complications of nerve and vascular injury. After the operation,the patients were examined by X-ray. The imaging of 32 patients(35 feet) showed recovery. The longest postoperative healing was 17 weeks and the shortest 8 weeks, with an average of(13.69±2.31) weeks. 3 cases(3 feet) had screw loosening and fusion failure reaction after operation, all of them were treated with modified surgery six months after operation. Before and after the operation, there was no statistically significant difference between the measurement indexes(t=1.298, 1.266, 0.743, 1.268,P>0.05);the AOFAS foot function scores after the operation were higher than those before the operation, and the difference between the two groups was statistically significant(t=14.924, 6.723, 5.363, 23.940, P<0.05).Conclusion For patients with ineffective conventional treatment, large pieces of parascaphoid bone, and no stiff flat feet, the treatment of parascaphoid fusion can effectively improve the pain response, improve the function of the affected limb, and have a high degree of satisfaction after surgery. The surgical effect is remarkable.