中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
4期
310-314
,共5页
跟距联合%距下关节%功能恢复%影响因素
跟距聯閤%距下關節%功能恢複%影響因素
근거연합%거하관절%공능회복%영향인소
talocalcaneal tarsal coalition%subtalar joint%function outcome%correlation factors
背景：成人跟距联合手术治疗方案临床报道较少，术后的功能评估尚不明确。目的：探讨影响成人跟距联合术后功能的相关因素，从而决定更好的手术方案。方法：回顾性研究2011年1月至2013年7月我院收治且获得完整随访资料的24例行跟距联合术的患者资料，男13例，女11例；年龄19~53岁，平均31.5岁。根据术前症状及影像学检查决定手术方案。记录患者年龄、跟距联合分型、跗骨联合的大小、有无距下骨关节炎、后足的外翻角度。应用美国足踝医师协会踝-后足评分表（AOFAS-AH）和踝关节Karlsson-Peterson评分对患者术后的踝关节功能进行评估，并对上述因素进行相关性分析。结果：24例患者获得平均19.5个月的随访（4~33个月）。单纯联合切除术19例，其中4例进行三角韧带修补，1例行外侧韧带重建，1例行跟骨截骨内移术。距下关节融合术5例，其中3例患者仍有疼痛症状。术后的AOFAS评分和Karlsson-Peterson评分均明显改善。经Logistic回归分析，距下关节骨关节炎是术后踝关节功能的影响因素，而跟距联合分型、跗骨联合的大小和后足的外翻角度无明显相关性。结论：距下关节骨关节炎影响跟距联合患者术后的踝关节功能评分，即使行距下关节融合术，在一定程度上也影响患者术后踝关节功能。
揹景：成人跟距聯閤手術治療方案臨床報道較少，術後的功能評估尚不明確。目的：探討影響成人跟距聯閤術後功能的相關因素，從而決定更好的手術方案。方法：迴顧性研究2011年1月至2013年7月我院收治且穫得完整隨訪資料的24例行跟距聯閤術的患者資料，男13例，女11例；年齡19~53歲，平均31.5歲。根據術前癥狀及影像學檢查決定手術方案。記錄患者年齡、跟距聯閤分型、跗骨聯閤的大小、有無距下骨關節炎、後足的外翻角度。應用美國足踝醫師協會踝-後足評分錶（AOFAS-AH）和踝關節Karlsson-Peterson評分對患者術後的踝關節功能進行評估，併對上述因素進行相關性分析。結果：24例患者穫得平均19.5箇月的隨訪（4~33箇月）。單純聯閤切除術19例，其中4例進行三角韌帶脩補，1例行外側韌帶重建，1例行跟骨截骨內移術。距下關節融閤術5例，其中3例患者仍有疼痛癥狀。術後的AOFAS評分和Karlsson-Peterson評分均明顯改善。經Logistic迴歸分析，距下關節骨關節炎是術後踝關節功能的影響因素，而跟距聯閤分型、跗骨聯閤的大小和後足的外翻角度無明顯相關性。結論：距下關節骨關節炎影響跟距聯閤患者術後的踝關節功能評分，即使行距下關節融閤術，在一定程度上也影響患者術後踝關節功能。
배경：성인근거연합수술치료방안림상보도교소，술후적공능평고상불명학。목적：탐토영향성인근거연합술후공능적상관인소，종이결정경호적수술방안。방법：회고성연구2011년1월지2013년7월아원수치차획득완정수방자료적24례행근거연합술적환자자료，남13례，녀11례；년령19~53세，평균31.5세。근거술전증상급영상학검사결정수술방안。기록환자년령、근거연합분형、부골연합적대소、유무거하골관절염、후족적외번각도。응용미국족과의사협회과-후족평분표（AOFAS-AH）화과관절Karlsson-Peterson평분대환자술후적과관절공능진행평고，병대상술인소진행상관성분석。결과：24례환자획득평균19.5개월적수방（4~33개월）。단순연합절제술19례，기중4례진행삼각인대수보，1례행외측인대중건，1례행근골절골내이술。거하관절융합술5례，기중3례환자잉유동통증상。술후적AOFAS평분화Karlsson-Peterson평분균명현개선。경Logistic회귀분석，거하관절골관절염시술후과관절공능적영향인소，이근거연합분형、부골연합적대소화후족적외번각도무명현상관성。결론：거하관절골관절염영향근거연합환자술후적과관절공능평분，즉사행거하관절융합술，재일정정도상야영향환자술후과관절공능。
Background:There are few reports on adult talocalcaneal coalition treatment. And the assessment of postoperative function has been still unclear. Objective:The purpose of this study is to find correlation factors of adult talocalcaneal coalition resection with regard to the better operation scheme. Methods:A total of 24 patients with talocalcaneal tarsal coalition were treated between January 2011 and July 2013. There were 11 females and 13 males, aged from 19 to 53 years (mean, 31.5 years). According to preoperative symptoms and radio-logical examinations, different operation schemes were performed. The age of patients, classification of talocalcaneal coali-tions, size of talocalcaneal coalitions, subtalar joint arthritis, and the angle of hindfoot valgus were recorded. AOFAS-AH and Karlsson-Peterson scores were used to evaluate the postoperative function of ankle. Correlation factors of postoperative outcomes were investigated. Results:Mean follow-up was 19.5 months (range, 4-33 months) in the 24 patients. Simple talocalcaneal coalitions resection was performed in 19 patients, including 4 of triangular ligament repair, lateral ligament reconstruction in one, and calcane-al osteotomy transfer operation in another one. Subtalar fusion was conducted in 5 patients, and 3 patients still felt pain post-operatively. Postoperative AOFAS score and Karlsson-Peterson score were significantly improved through the paired t test analysis. Logistic regression analysis showed that the osteoarthritis of subtalar joint was significantly correlated with postop-erative outcome, while the classification of talocalcaneal coalitions, the size of talocalcaneal coalitions and the angle of hind-foot valgus were not significantly correlated with clinical outcome. Conclusions:The osteoarthritis of subtalar joint will influence ankle joint function in the patients with talocalcaneal coali-tions. Even if the subtalar arthrodesis is performed, postoperative ankle joint function will be limited to some extent.
