距下关节稳定器对青年柔韧性扁平足的生物力学影响与矫形效果观察

Biomechanical and orthopaedic effects of inferior talar joint stabilizer on flexible flatfoot in youth

目的研究HyProCure距下关节稳定器对青年柔韧性扁平足的生物力学影响,并且观察其矫形效果。方法回顾性分析自2017-01—2021-01采用HyProCure距下关节稳定器联合附加手术治疗的65例(78足)青年MyersonⅡ期柔韧性扁平足,将HyProCure距下关节稳定器置入后结合术中透视情况及扁平足畸形矫正程度予以相应附加手术。比较手术前后疼痛VAS评分、Maryland足部评分、影像学测量参数。结果65例均获得至少1年随访。末次随访时疼痛VAS评分、Maryland足部评分较术前明显改善,差异有统计学意义(P<0.05)。术后1个月距骨第1跖骨角、跟骨倾斜角、距舟覆盖角、第1跖楔关节高度较术前明显改善,差异有统计学意义(P<0.05)。61例治疗效果较为理想,其中54例(65足)显效,7例(9足)有效。4例(4足)无效,而且患者负重行走时出现跗骨窦周围疼痛,二次手术时取出原来置入的距下关节稳定器,更换合适的HyProCure距下关节稳定器,继续随访未再次出现疼痛。结论HyProCure距下关节稳定器联合附加手术治疗青年MyersonⅡ期柔韧性扁平足的短中期疗效满意,能够矫正MyersonⅡ期柔韧性扁平足患者的生物力学结构异常,明显减轻行走时疼痛,改善足部功能。

Objective To study the biomechanical effects of the HyProCure subtalar joint stabilizer on flexible flatfoot in youth and to observe its orthopaedic effects.Methods Sixty-five cases(78 feet)of Myerson stageⅡflexible flatfoot treated with Hy⁃ProCure subtalar joint stabilizer combined with additional surgery from January 2017 to January 2021 were retrospectively ana⁃lyzed.The HyProCure subtalar joint stabilizer was inserted and according to intraoperative fluoroscopy and the degree of flatfoot deformity correction,the additional surgery was performed.Pain VAS scores,Maryland foot scores,and imaging parameters were compared before and after surgery.Results All 65 cases were followed up for at least 1 year.The pain VAS score and Maryland foot score at the last follow-up were significantly improved compared with those before surgery,and the difference was statistically significant(P<0.05).The treatment results were satisfactory in 61 cases,of which 54 cases(65 feet)were significant⁃ly effective,7 cases(9 feet)were effective while 4 cases(4 feet)were ineffective and the patients experienced pain around the tarsal sinus during weight-bearing walking.The original subtalar joint stabilizer was removed during the second surgery and re⁃placed with a suitable HyProCure subtalar joint stabilizer,and the pain did not reappear at follow-up.Conclusion The HyPro⁃Cure subtalar joint stabilizer combined with additional surgery is effective in the short to medium term in the treatment of Myer⁃son’s stageⅡflexural flatfoot in young adults,correcting the biomechanical abnormalities in Myerson’s stageⅡflexural flat⁃foot,significantly reducing pain during walking,and improving foot function.