摘要
目的评估跗骨窦内植骨充填行距下关节融合肌腱修复矫形术治疗严重距下关节骨关节炎伴有胫后肌腱功能不良的疗效。方法2000年10月～2006年2月,对31例严重距下关节骨关节炎伴有期胫后肌腱功能不良的患者施行手术。男18例,女13例;年龄23～62岁,平均36.4岁。右足15例,左足16例。发病原因:退行性骨关节炎14例,损伤后遗症8例,感染7例,足部畸形肌腱解剖结构异常2例。发病至手术时间为6～30个月,平均9.5个月。将损伤部位的肌腱进行修复后,在跗骨窦内以自体髂骨植骨并行距下关节融合手术,所有患者均根据美国足踝外科协会(American Orthopodics Foot and Ankle Society,AOFAS)的足与踝关节评分法进行术前、术后相关评估。结果术后28例获随访8～61个月,平均23.6个月。AOFAS评分:术前平均为45.30±1.08分,术后平均为79.60±2.14分;疼痛指数:术前平均为15.40±2.23,术后平均为38.50±2.61;足踝关节功能指数:术前平均为21.6±3.01,术后平均为37.40±2.83。所有评估指标术前、后比较,差异均有统计学意义(P<0.01)。跟骨正位X线片示术前、后距骨纵轴线与跟骨纵轴线交角平均值分别为43.70±1.06°和29.40±0.98°,侧位跟距角分别为48.20±0.85°和39.40±1.02°,术前、后比较差异有统计学意义(P<0.01)。踝关节背屈度术前、后分别为39.0±2.4°和38.0±3.2°,跖屈度术前、后分别为19.0±7.4°和18.0±6.5°,手术前、后比较差异无统计学意义(P>0.05)。结论距下关节融合联合跗骨窦内植骨与肌腱修复术,纠正了后足畸形,保留了邻近跗骨间关节的活动,为治疗严重距下关节骨关节炎伴有期胫后肌腱功能不良获得了良好效果。
Objective To assess the curative effect of the subtalar arthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction. Methods From October 2000 to February 2006, 31 patients （18 males, 13 females; age 23-62 years, averaged 36.4 years） with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients, sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9. 5 months （range, 6-30 months）. Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system （American Orthopedics Foot and Ankle Society, AOFAS）. Results Among the patients, 28 were followed up on an average of 23.6 months （range, 8-61 months）. The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 after operation. The pain indexes ranged from 15.40±2.23 before operation to 38. 50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3. 01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between before operation and after operation （P〈0.01）. The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0. 98° after operation, and the deviation angles between the calcaneal line and the talus were 48. 20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation （P〈0.01）. Conclusion The subtalar arthrodesis combined with the bone gr
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第8期854-856,共3页
Chinese Journal of Reparative and Reconstructive Surgery
基金
上海市重点学科资助项目(T0303)~~
关键词
距下关节
骨关节炎
关节融合
胫后肌腱
功能不良
Subtalar joint Osteoarthritis Arthrodesis Posterior tibial tendon Dysfunction
