CAJ | 학술논문

目的探讨三关节截骨矫形融合治疗ⅡB和Ⅲ期成年人获得性平足症的疗效.方法 2008年1月至2009年12月采用距下、距舟和跟骰三关节截骨矫形融合治疗10例(ⅡB3例、Ⅲ期7例)成年人获得性平足症患者.手术取内外侧联合人路显露距下、距舟和跟骰关节;完整去除关节软骨;予以适当截骨矫形、维持足于理想位置并用克氏针临时固定.选用两枚直径7.3 mm空心螺钉固定距下关节;再分别用两枚直径4.5 mm空心螺钉由远及近固定距舟关节和跟骰关节.术前、术后采用AOFAS功能评分表进行疗效分析,同时观察疼痛缓解、功能、外观及满意度等.影像学评估包括骨愈合时间,前后位距骨-第1跖骨角、侧位跟距角、侧位距骨-第1跖骨角等.结果 10例患者术后全部获得随防,平均随访13.2个月(6～21个月).AOFAS功能评分从术前平均(39.4±4.4)分升高到术后(83.7 ±2.6)分,所有病人在疼痛、功能及外观上均有改善,对治疗结果满意.X线片显示:距下、距舟和跟骰关节均达到骨性愈合;前后位距骨-第1跖骨角、侧位跟距角、侧位距骨-第1跖骨角等均有显著改善.本组没有发现伤口感染、骨不连等并发症.结论三关节截骨矫形融合是一种治疗ⅡB和Ⅲ期成年人获得性平足症的理想手术,可以明显缓解疼痛,有效矫正畸形,获得较好的临床疗效.
목적 탐토삼관절절골교형융합치료ⅡB화Ⅲ기성년인획득성평족증적료효.방법 2008년1월지2009년12월채용거하、거주화근투삼관절절골교형융합치료10례(ⅡB3례、Ⅲ기7례)성년인획득성평족증환자.수술취내외측연합인로현로거하、거주화근투관절;완정거제관절연골;여이괄당절골교형、유지족우이상위치병용극씨침림시고정.선용량매직경7.3 mm공심라정고정거하관절;재분별용량매직경4.5 mm공심라정유원급근고정거주관절화근투관절.술전、술후채용AOFAS공능평분표진행료효분석,동시관찰동통완해、공능、외관급만의도등.영상학평고포괄골유합시간,전후위거골-제1척골각、측위근거각、측위거골-제1척골각등.결과 10례환자술후전부획득수방,평균수방13.2개월(6～21개월).AOFAS공능평분종술전평균(39.4±4.4)분승고도술후(83.7 ±2.6)분,소유병인재동통、공능급외관상균유개선,대치료결과만의.X선편현시:거하、거주화근투관절균체도골성유합;전후위거골-제1척골각、측위근거각、측위거골-제1척골각등균유현저개선.본조몰유발현상구감염、골불련등병발증.결론 삼관절절골교형융합시일충치료ⅡB화Ⅲ기성년인획득성평족증적이상수술,가이명현완해동통,유효교정기형,획득교호적림상료효.
Objective To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage ⅡB and Stage Ⅲ adult-acquired flatfoot. Methods The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage ⅡB adult-acquired flatfoot and 7 cases of stage Ⅲ adultacquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ),talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomied to restore their proper alignments. The optimal positioning of hindfoot could be gchieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses. Results All patients were followedup with a mean time of 13.2 (6-21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2. 6 postoperatively ( P ＜ 0.01 ). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied.Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle,lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported. Conclusion Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage ⅡB and Ⅲ adult-acquired flatfoot deformity. It may relieve pains,correct structural deformities and obtain excellent clinical outcomes.