两种术式治疗青少年Ⅱ型疼痛性副舟骨比较

Comparison of two surgical treatments for typeⅡpainful accessory navicular syndrome in adolescents

[目的]比较分析Kidner术与副舟骨融合术治疗青少年Ⅱ型疼痛性副舟骨的临床疗效。[方法]2016年1月~2019年1月经本院手术治疗的青少年Ⅱ型疼痛性副舟骨患者30例。根据手术方式不同将患者分为两组,15患者应用Kidner术,15例患者应用融合术。比较两组围手术期、随访和影像资料。[结果]所有患者均顺利完成手术,均无严重并发症。Kidner组手术时间[(50.36±3.26)min vs(65.72±5.40)min,P<0.05]及术中透视次数[(1.23±0.32)次vs(3.15±0.22)次,P<0.05]均显著少于融合组。所有患者随访12~36个月,平均(20.63±8.42)个月。Kidner组恢复下地行走[(4.21±1.27)周vs(6.31±1.41)周,P<0.05]和完全负重活动[(6.03±1.36)周vs(8.21±2.32)周,P<0.05]均显著早于融合组。随时间推移,两组患者VAS评分显著减少(P<0.05),而AOFAS评分显著增加(P<0.05)。术后3个月和术后12个月,Kidner组的VAS评分均显著小于融合组(P<0.05),但两组间AOFAS评分的差异无统计学意义(P>0.05)。影像学方面,与术前相比,术后两组患者的Meary角、Pitch角和TCA角均无显著变化(P>0.05),相应时间点,两组间Meary角、Pitch角和TCA角的差异均无统计学意义(P>0.05)。[结论]两种术式均可有效治疗青少年Ⅱ型疼痛性副舟骨,相比之下,Kidner术的临床结果优于融合术。

[Objective]To compare the clinical outcomes of Kidner procedure versus accessory navicular fusion for typeⅡpainful accessory navicular syndrome(ANS)in adolescents.[Methods]From January 2016 to January 2019,30 adolescent patients received surgical treatment for typeⅡpainful ANS in our hospital.According to operation methods,the patients were divided into two groups with 15 patients in each group.Of them,15 patients received Kidner procedure,while the other 15 patients underwent accessory navicular fusion.The perioperative,follow-up and imaging data were compared between the two groups.[Results]All the patients in both groups had operations completed successfully without serious complications.The Kidner group was significantly superior to the fusion group regarding to operation time[(50.36±3.26)min versus(65.72±5.40)min,P<0.05]and intraoperative fluoroscopy times[(1.23±0.32)times versus(3.15±0.22)times,P<0.05].All patients were followed up for 12~36 months with an average of(20.63±8.42)months.The Kidner group resumed walking[(4.21±1.27)weeks versus(6.31±1.41)weeks,P<0.05]and full weight-bearing activity[(6.03±1.36)weeks vs(8.21±2.32)weeks,P<0.05]significantly earlier than the fusion group.The VAS scores decreased significantly(P<0.05),while the AOFAS scores increased significantly in both groups over time(P<0.05).At 3 and 12 months after operation,the Kidner group had significantly lower VAS score than the fusion group(P<0.05),although no statistically significant differences in AOFAS score was noted between the two groups(P>0.05).In terms of radiographic evaluation,there were no significant changes in Meary angle,Pitch angle and TCA angle in both groups postoperatively compared with those preoperatively(P>0.05).At the corresponding time point,there was no statistically significant difference in above radiographic measurements between the two groups(P>0.05).[Conclusion]Both surgical methods are effective to treat typeⅡpainful ANS in adolescent.In contrast,Kidner procedure achieves better clinical outcomes than accessory navicular fusion.