CAJ | 학술논문

目的探讨中足关节融合术治疗陈旧性中足骨折脱位致创伤性平足症的临床疗效. 方法 2009年1月至201 1年10月采用关节融合术治疗陈旧性中足损伤后成人创伤性平足症15例,其中男10例,女5例；年龄22～57岁,平均38.4岁；左足8例,右足7例.比较术前和末次随访时足部力线改变情况,并采用美国足踝外科协会(AOFAS)中足评分和视觉模拟评分(VAS)评估功能预后. 结果 12例患者术后获平均23个月(12 ～37个月)随访.末次随访时距骨-第1跖骨角(14.7°±3.7°)、距骨-第2跖骨角(18.9°±2.9°)、距骨-跖骨角(3.4°±1.2°)较术前(26.1°±8.9°、28.6°±12.7°、10.7°±6.7°)减小,差异均有统计学意义(P＜0.05).末次随访时距骨-跟骨角(24.6°±4.3°)较术前(21.3°±4.7°)增加,差异无统计学意义(P＞ 0.05).末次随访时AOFAS中足评分[(81.5±6.3)分]、VAS评分[(2.6±0.9)分]较术前[(30.5±14.9)分、(5.7±0.9)]明显改善,差异均有统计学意义(P＜0.05). 结论中足融合术可以明显改善创伤性平足症患者的足部力线和外形,稳定足弓,且可较好地缓解临床症状.但多数患者仍无法完全恢复伤前活动能力,早期诊断和合理治疗对中足骨折脱位仍非常关键.
목적 탐토중족관절융합술치료진구성중족골절탈위치창상성평족증적림상료효. 방법 2009년1월지201 1년10월채용관절융합술치료진구성중족손상후성인창상성평족증15례,기중남10례,녀5례；년령22～57세,평균38.4세；좌족8례,우족7례.비교술전화말차수방시족부력선개변정황,병채용미국족과외과협회(AOFAS)중족평분화시각모의평분(VAS)평고공능예후. 결과 12례환자술후획평균23개월(12 ～37개월)수방.말차수방시거골-제1척골각(14.7°±3.7°)、거골-제2척골각(18.9°±2.9°)、거골-척골각(3.4°±1.2°)교술전(26.1°±8.9°、28.6°±12.7°、10.7°±6.7°)감소,차이균유통계학의의(P＜0.05).말차수방시거골-근골각(24.6°±4.3°)교술전(21.3°±4.7°)증가,차이무통계학의의(P＞ 0.05).말차수방시AOFAS중족평분[(81.5±6.3)분]、VAS평분[(2.6±0.9)분]교술전[(30.5±14.9)분、(5.7±0.9)]명현개선,차이균유통계학의의(P＜0.05). 결론 중족융합술가이명현개선창상성평족증환자적족부력선화외형,은정족궁,차가교호지완해림상증상.단다수환자잉무법완전회복상전활동능력,조기진단화합리치료대중족골절탈위잉비상관건.
Objective To evaluate the short to mid-term outcomes of arthrodesis for traumatic fiat foot caused by midtarsal fracture dislocation.Methods From January 2009 to October 2011,15 patients with traumatic flat foot caused by midtarsal fracture dislocation were treated by arthrodesis in our department.They were 10 males and 5 females,with a mean age of 38.4 years (range,22 to 57 years).Eight fiat feet were left and 7 were right.A retrospective analysis was performed to evaluate alignment of the treated foot between pre-and post-operation and functional recovery at the final follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) mid-foot score and visual analogue scale (VAS).Results A total of 12 cases were followed for a mean time of 23 months (range,12 to 37 months).The first and second metatarsal angles were significantly improved (P ＜ 0.05) on the anterior-posterior X-ray films of weight-bearing foot.On the lateral X-ray films of weight-bearing foot,the Meary' s angle was also significantly improved (P ＜ 0.05)but the talocalcaneal angle was improved with no significant difference.The mean post-operative AOFAS mid-foot score was significantly higher than the pre-operative one (30.5 ± 14.9 vs.81.5 ± 6.3,P ＜ 0.05).The mean VAS score was significantly improved too (P ＜ 0.05).Calcaneocuboid joint nonunion was found in one patient and skin necrosis in 2 but no deep infection or osteomyelitis was found.Conclusions Midtarsal arthrodesis can significantly improve the alignment of a traumatic fiat foot caused by midtarsal fracture dislocation,stabilize the arch of foot and improve the symptoms.However,most of the patients can not reach the pro-injury motion level,and early diagnosis and rational treatment are still important to patients with midtarsal injury.