CAJ | 학술논문

目的：探讨距下关节制动术在治疗儿童柔韧性扁平足中的矫形效果，并对其疗效进行评价。方法回顾性分析2012年8月至2013年10月接受距下关节制动术治疗的15例柔韧性扁平足患儿的诊治结果，分别测量和分析术前、术后前后位片上距跟角、距-第一跖骨角和侧位片上距-第一跖骨角、距骨倾斜角，并用 Maryland 足部评分系统对术前、术后情况进行评价。结果14例患儿获得随访，随访时间为6~20个月。随访病例均无重要血管神经损伤等并发症发生。术后患足疼痛及足弓塌陷等症状均明显好转。前后位片上距跟角平均由术前26.6°±2.5°减小到术后20.8°±2.1°(P<0.05)，距-第一跖骨角平均由术前13.7°±1.8°减小到术后6.4°±1.3°(P <0.05)，侧位片上距骨倾斜角平均由术前27.9°±2.4°减小到术后20.7°±2.2°(P <0.05)，距骨-第一跖骨角平均由术前11.4°±1.3°减小到术后3.7°±1.1°(P <0.05)。术前、术后均采用 Maryland 足部评分系统进行评价，平均由术前(58.2±6.7)分提高到术后(86.4±5.6)分(P <0.05)。结论距下关节制动术是治疗儿童柔韧性扁平足的有效方法，具有简单、安全、创伤小，术后并发症少等优点，但此项技术在国内开展的时间不是太长，还需进一步观察其远期疗效。
목적：탐토거하관절제동술재치료인동유인성편평족중적교형효과，병대기료효진행평개。방법회고성분석2012년8월지2013년10월접수거하관절제동술치료적15례유인성편평족환인적진치결과，분별측량화분석술전、술후전후위편상거근각、거-제일척골각화측위편상거-제일척골각、거골경사각，병용 Maryland 족부평분계통대술전、술후정황진행평개。결과14례환인획득수방，수방시간위6~20개월。수방병례균무중요혈관신경손상등병발증발생。술후환족동통급족궁탑함등증상균명현호전。전후위편상거근각평균유술전26.6°±2.5°감소도술후20.8°±2.1°(P<0.05)，거-제일척골각평균유술전13.7°±1.8°감소도술후6.4°±1.3°(P <0.05)，측위편상거골경사각평균유술전27.9°±2.4°감소도술후20.7°±2.2°(P <0.05)，거골-제일척골각평균유술전11.4°±1.3°감소도술후3.7°±1.1°(P <0.05)。술전、술후균채용 Maryland 족부평분계통진행평개，평균유술전(58.2±6.7)분제고도술후(86.4±5.6)분(P <0.05)。결론거하관절제동술시치료인동유인성편평족적유효방법，구유간단、안전、창상소，술후병발증소등우점，단차항기술재국내개전적시간불시태장，환수진일보관찰기원기료효。
Objective To explore the efficacies of subtalar arthrorisis correction in pediatric flexible flatfoot.Methods From August 2012 to October 2013,retrospective analyses were conducted for 1 5 flexible flatfoot cases undergoing subtalar arthrorisis.We measured the talo calcaneal angles and talar-first metatarsal angles on anteroposterior films and talar-first metatarsal angles and talar decline angles on lateral films.At the same time,the Maryland Foot Score was employed to evaluate and analyze the preoperative and postoperative status.Results During a follow-up period of 6-20 months, there was no onset of vascular or nerve injuries for 14 patients.Postoperatively foot pain,arch collapse and other symptoms obviously improved.On anteroposterior films,anteroposterior distance angles declined from preoperative 26.6°±2.5°to postoperative 20.8°±2.1°(P <0.05),talar-first metatarsal angles decreased from preoperative 13.7°± 1 .8° to postoperative 6.4°± 1 .3° (P <0.05);on lateral films,talar angles declined from preoperative 27.9°± 2.4° to postoperative 20.7°± 2.2° (P < 0.05) while talar-first metatarsal angles decreased from preoperative 1 1 .4°± 1 .3° to postoperative 3.7°± 1 .1°(P <0.05).Before and after surgery,the mean Maryland foot scores rose from preoperative (58.2 ±6.7)points to (86.4±5.6)points post-operation(P <0.05).Conclusions As an effective treatment for flexible flatfoot,subtalar arthrorisis offers the advantages of simple operation,safety,mini-trauma, short operative duration,fewer postoperative complications and better outcomes.It is worthy of wider promotion and further development in clinic practice.