目的:探讨跟骨截骨联合kidner手术治疗副舟骨源性平足症患者的应用方法及临床效果。方法:选取2016年1月— 2020年12月本院收治的副舟骨源性平足症患者30例,均接受跟骨截骨联合kidner手术治疗,治疗后进行6个月随访,比较患者术前和末次随访的各项临床指标。结果:30例副舟骨源性平足症患者在术前的T1M1角(16.5±1.9)°、TCA角(20.7±2.4)°、Meary's角(10.6±1.6)°、Pitch角(13.2±0.9)°、Kite角(42.6±1.6)°、VAS(5.2±1.0)分和Maryland足功能评分(46.9±4.3)分,患者末次随访的T1M1角(8.6±1.6)°、TCA角(11.1±1.6)°、Meary's角(4.6±0.9)°、Pitch角(22.7±2.1)°、Kite角(37.7±0.9)°、VAS评分(2.1±0.7)分和Maryland足功能评分(92.0±1.7)分,差异均具有统计学意义(P<0.05)。该种方法的临床治疗安全性相对较高,所有副舟骨源性平足症患者的切口位置均为Ⅰ期愈合。结论:采用跟骨截骨联合kidner手术方法,可以显著改善副舟骨源性平足症患者的各项临床指标,明显缓解患者疼痛,治疗安全性高,值得在临床治疗工作中进一步推广。
Objective: To investigate the application and clinical effect of Calcaneus osteotomy combined with kidner's operation in the treatment of patients with accessory navicular Plantar Syndrome. Methods: A total of 30 patients with accessory navicular Plantar Syndrome from January 2016 to December 2020 were selected as the study subjects. All patients received Calcaneus osteotomy combined with kidner's operation, and were followed up for 6 months after treatment. All the 30 patients were compared with each clinical index of preoperative and final follow-up. Results: After data analysis can be found, pREOPERATIVE T1M1 angle (16.5±1.9)° , TCA angle (20.7±2.4)° , Meary's angle (10.6±1.6)° , Pitch angle (13.2±0.9)° , angle angle (42.6±1.6)° , Vas score (5.2±1.0) and Maryland foot function score (46.9±4.3) in 30 patients with accessory navicular Plantar Syndrome, there were significant differences in the scores of (8.6±1.6)° , (11.1±1.6)° , (4.6±0.9)° , (22.7±2.1)° , (37.7±0.9)° , (2.1±0.7)° and (92.0±1.7) with the last follow-up data (P<0.05) . Moreover, the clinical safety of this method is relatively high, all patients with accessory navicular Plantar Syndrome incision site for Phase I healing. Conclusion: Calcaneus osteotomy combined with kidner's operation can significantly improve the clinical indexes of patients with accessory navicular Plantar Syndrome and relieve the degree of pain, so that patients with accessory navicular Plantar Syndrome have a good treatment experience, it is worthy of further promotion in the future clinical treatment.
[1] Toullec E. Adult flatfoot[J]. Orthop Traumatol Surg Res, 2015 ,101(1 Suppl):S11-17.
[2] 王正义, 唐康来. 重视成年人平足症的诊断与治疗[J]. 中华医学杂志, 2010, 90(33):2305-2307.
[3] 辛亮, 李承罡. 改良型内侧切口双关节融合术治疗成人获得性平足症[J].山西医药杂志, 2018, 47(10):92-94.
[4] 张兴飞,许亚军.平足症骨性手术研究现状[J].医学综述,2019, 25(7):143-147.
[5] 肖晟, 李波.副舟骨切除联合胫后肌腱重建治疗儿童疼痛性副舟骨中期疗效[J]. 实用骨科杂志, 2019,25(10):941-943.
[6] 张宇,张挥武,李平, 等. 骨与软组织联合手术治疗伴有痛性副舟骨的柔软性平足症[J].中国骨伤, 2019, 32(1):77-81.
[7] 曹洪辉, 唐康来,邓银栓,等.副舟骨切除结合胫后肌腱止点前置重建治疗副舟骨源性平足症[J].中国修复重建外科杂志, 2012, 26(6):686-690.
[8] 曹洪辉, 张传志, 卢卫忠,等. 副舟骨源性平足症发病特点分析[J].生物骨科材料与临床研究, 2015,12(3):44-46.
[9] 邓银栓, 高秋明, 甄平,等. 副舟骨源性平足症的手术治疗策略[J]. 中国骨伤, 2015, 28(2):188-194.
[10] 赵炼, 刘韶, 徐军奎,等. 儿童柔韧性平足症的手术治疗进展[J]. 医学综述, 2018, 24(10): 2004-2008,2015.
[11] Ellis SJ, Williams BR, Garg R, et al. Incidence of plantar lateral foot pain before and after the use of trial metal wedges in lateral column lengthening[J]. Foot Ankle Int, 2011,32(7):665-673.
[12] 燕晓宇, 俞光荣. 跟骨内移截骨术在平足症治疗中的应用[J].临床骨科杂志, 2005, 8(2):187-190.
[13] Kopp FJ,Marcus RE. Clinical outcome of surgical treatment of the symptomatic accessory navicular.[J]. Foot Ankle Int, 2004, 25(1):27-30.
[14] 陈成, 唐康来, 胡超,等. 副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症[J]. 中华骨科杂志, 2013, 33(4):377-382.