CAJ | 학술논문

目的探讨小切口跟骨内移截骨治疗胫后肌腱功能不全性柔韧性平足症的疗效.方法自2005年6月至2009年6月采用小切口跟骨内移截骨治疗10例(13足)胫后肌腱功能不全性柔韧性平足症,所有患者足跟存在明显外翻畸形.取外侧人路3.0～4.5 cm暴露跟骨外侧壁,垂直于跟骨体截断跟骨,远端向内侧平行推移约跟骨体直径1/3～1/2,用两枚空心螺钉平行加压固定.术前,术后6周,3、6、12个月及以后每6个月进行1次临床及影像学评估.所有病人采用AOFAS评分表进行功能评估.站立位摄全足侧位片,了解截骨愈合情况,测定跟骨倾斜角、跟距角、距骨-第1跖骨角变化情况;站立位摄全足前后位片,了解跟距角、距骨-第1跖骨角变化情况;摄后跟轴位片评价外翻力线变化情况.结果所有病人均得到有效随访,平均随访20.3个月(7～55个月),临床与影像学证明10例13足全都获得骨性愈合.AOFAS评分由术前平均50.3分提高到术后随访84.2分.没有感染、神经损伤等并发症.术后侧位跟骨倾斜角、跟距角、距骨-第1跖骨角,前后位跟距角、距骨-第1跖骨角较术前明显改善,差异有统计学意义(P＜0.01);后跟轴位提示所有病人后跟外翻畸形得到纠正.结论小切口跟骨内移截骨术治胫后肌腱功能不全性柔韧性平足症临床效果好,能有效纠正平足畸形,改善踝-后足功能,并发症少,是一种值得推荐的手术方法.
목적 탐토소절구근골내이절골치료경후기건공능불전성유인성평족증적료효.방법 자2005년6월지2009년6월채용소절구근골내이절골치료10례(13족)경후기건공능불전성유인성평족증,소유환자족근존재명현외번기형.취외측인로3.0～4.5 cm폭로근골외측벽,수직우근골체절단근골,원단향내측평행추이약근골체직경1/3～1/2,용량매공심라정평행가압고정.술전,술후6주,3、6、12개월급이후매6개월진행1차림상급영상학평고.소유병인채용AOFAS평분표진행공능평고.참립위섭전족측위편,료해절골유합정황,측정근골경사각、근거각、거골-제1척골각변화정황;참립위섭전족전후위편,료해근거각、거골-제1척골각변화정황;섭후근축위편평개외번력선변화정황.결과 소유병인균득도유효수방,평균수방20.3개월(7～55개월),림상여영상학증명10례13족전도획득골성유합.AOFAS평분유술전평균50.3분제고도술후수방84.2분.몰유감염、신경손상등병발증.술후측위근골경사각、근거각、거골-제1척골각,전후위근거각、거골-제1척골각교술전명현개선,차이유통계학의의(P＜0.01);후근축위제시소유병인후근외번기형득도규정.결론 소절구근골내이절골술치경후기건공능불전성유인성평족증림상효과호,능유효규정평족기형,개선과-후족공능,병발증소,시일충치득추천적수술방법.
Objective To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction. Methods From 2005 to 2009, 10 patients ( 13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteetomy with mini-incision. The lateral skin incision of 3.0-4. 5cm was made to explore the lateral calcaneal wall Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3 - 1/2 width of calcaneal body and fixed by two parallelcannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI),talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot.Results With a mean postoperative follow-up period of 20. 3 months ( range 7-55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50. 3 to a mean of 80. 2 at 6 months and a mean of 84. 2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P ＜0. 001 ), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view. Conclusion The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.