跟距骨桥分型与治疗的研究进展

Research on classification and treatment of talocalcaneal bridge

跟距骨桥多发生于跟距关节内侧,在足跗骨畸形中占比最高,绝大多数患者无明显症状,发病时多表现为疼痛、距下关节活动障碍。跟距骨桥的分型多种多样,不同的分型对于临床的指导意义不同。目前临床上应用最广的是Rozansky分型,对临床治疗有一定指导意义;Lim分型则更为简单全面,而对于合并足部畸形或者骨关节炎推荐使用Blitz分型。在治疗方面,轻微症状患者建议保守治疗;保守治疗失败的患者可以选择关节镜下手术切除骨桥,而面积较大(>50%距下关节面)、多关节面骨桥、畸形严重的患者可选择切开手术,Ⅰ期或Ⅱ期处理合并平足畸形;对于多次关节镜或切开手术失败,合并严重骨关节炎或者复杂的跟距骨桥患者可选距下关节或三关节融合术,并矫正畸形。

Talocalcaneal bridge mostly occurs on the inner side of heel-talar joint,and accounts for the highest proportion of foot tarsal deformities.Most of patients have no obvious symptoms,and manifested as pain and subtalar joint dysfunction at the onset.There are many types of calcaneal talus bridge,and different types have different clinical guiding significance.At present,Rozansky classification is the most widely used clinically,which has certain guiding significance for clinical treatment;Lim classification is simpler and more comprehensive,and Blitz classification is recommended for combined foot deformities or osteoarthritis.In terms of treatment,conservative treatment is recommended for patients with mild symptoms;patients who fail conservative treatment could choose arthroscopic surgery to remove bone bridge,while patients with larger areas(>50%subtalar articular surface),multi-articular bone bridges,and severe deformities incision surgery could be selected,the first or second stage treatment combined with flat foot deformity;for patients with multiple arthroscopic or incision surgery failures,severe osteoarthritis,or complex talocalcaneal bridge,subtalar joint or tri-articular fusion could be selected,and correct deformity.