截骨矫形联合软组织手术治疗高弓内翻足伴跖内收的短期疗效

Short-term Efficacy of Osteotomy Combined with Soft Tissue Surgery in the Treatment of Cavovarus Foot with Metatarsal Adduction

目的 探讨跖骨截骨联合跟骨截骨以及软组织手术治疗高弓内翻足伴跖内收的短期疗效。方法 回顾性分析2018年2月至2021年9月我院采用跖骨截骨联合跟骨截骨以及软组织手术治疗的14例(16足)高弓内翻足伴跖内收病人的临床资料。男6例(6足),女8例(10足);单左足5例,单右足7例,双足2例;平均年龄为24.5岁(18~35岁),病程3~10年。病人术前均有足部的高弓内翻畸形伴疼痛,保守治疗无效。根据术前负重位X线片测量跖内收角(MAA)评估前足内收程度,中度10足,重度6足。评估术前及末次随访时的MAA、距骨第1跖骨角、跟骨倾斜角、后足力线位跟骨外翻角和美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评分。结果 术后病人伤口均一期愈合。1例(1足)术后4个月穿正常鞋下地行走时出现转移性跖痛,配矫形鞋垫后症状消失。14例(16足)病人均获得了随访,随访时间为18~24个月,平均21.4个月。末次随访时,MAA为8.53°±0.69°,距骨第1跖骨角为3.58°±0.52°,跟骨倾斜角为24.75°±2.77°,跟骨外翻角为2.67°±1.78°,AOFAS评分为(90.08±5.62)分,均明显优于术前[25.89°±3.62°,8.67°±1.97°,38.17°±7.83°,-29.08°±8.51°,(45.08±9.09)分],差异有统计学意义(P<0.05)。结论 跖骨截骨联合跟骨截骨以及软组织手术治疗高弓内翻足伴跖内收的短期疗效显著。

Objective To investigate the short-term effects of metatarsal osteotomy combined with calcaneal osteotomy and soft tissue surgery in the treatment of cavovarus foot with metatarsal adduction.Methods The clinical data of 14 patients(16 feet)with cavovarus foot with metatarsal adduction treated by metatarsal osteotomy combined with calcaneal osteotomy and soft tissue surgery in our hospital from February 2018 to September 2021 were retrospectively analyzed.There were 6 males(6 feet)and 8 females(10 feet).The lesions occurred on the individual left foot(5 cases),individual right foot(7 cases),and bifoot(2 cases).The mean age was 24.5 years(18 to 35 years),and the course of disease was 3 to 10 years.All patients had cavovarus deformity of the foot with pain before surgery,which failed to respond to conservative treatment.The degree of forefoot adduction was evaluated according to the plantar adduction angle(MAA)measured by preoperative weight-bearing radiographs.There were 10 moderate cases and 6 severe cases.The MAA,the angle of the 1st metatarsal of the talus,the angle of calcaneal inclination,the heel varus angle at the posterior foot position,and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle and posterior foot function score were evaluated preoperation and at the last follow-up.Results All the wounds healed in one stage after operation.One case(one foot)had metastatic plantar pain when walking with normal shoes 4 months after operation,but the symptoms disappeared after the application of orthopedic insole.A total of 14 patients(16 feet)were followed up for 18-24 months(mean 21.4 months).At the last follow-up,the MAA was 8.53°±0.69°the angle of the first metatarsal of the talus was 3.58°±0.52°,the inclination angle of the calcaneus was 24.75°±2.77°,the varus angle of the calcaneus was 2.67°±1.78°,and the AOFAS score was(90.08±5.62),which were significantly better than those before operation[25.89°±3.62°,8.67°±1.97°,38.17°±7.83°,-29.08°±8.51°,(45.08±9.09)points],and the difference was statistically significant(P<0.05).Conclusion The metatarsal osteotomy combined with calcaneal osteotomy and soft tissue surgery in the treatment of cavovarus foot with metatarsal adduction can obtain a significant short-term effect.