摘要
目的 探讨选择性中足关节融合治疗创伤性平足症的手术方法和中短期疗效.方法 2009年3月～ 2012年5月,通过关节融合手术治疗中足损伤后成年人创伤性平足症22例,其中男性15例,女性7例;平均年龄39.2岁（21～58岁）;左足14例,右足8例.通过回顾性研究,比较术前及术后末次随访时足部力线改变情况,并通过美国足踝骨科协会（AOFAS）中足评分和VAS疼痛评分评估中足功能的预后.结果 有20例患者获得随访,平均随访25个月（14 ～ 42个月）.足负重正位X线片上距骨第1跖骨角和距骨第2跖骨角均有显著改善（P＜0.05）;足负重侧位片上Meary角有显著改善（P＜0.01）,距骨跟骨角较之术前有增加,但未获得显著差异.术后平均AOFAS中足评分较术前有显著提高（30.5±14.9 vs.81.5±6.3,P＜0.01）,VAS疼痛评分也有显著改善（P＜0.01）.有1例跟骰关节融合不愈合,2例切口皮缘坏死,未出现深部感染或骨髓炎.结论 中足融合手术可以显著改善创伤性平足患者的足部力线及外形,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.
Objective To evaluate the operation method and short- and mid-term effect of selective arthrodesis in the treatment of traumatic flatfoot. Method From March 2009 to May 2012, the 22 traumatic flatfoot patients caused by midtarsal fracture were treated with arthrodesis in our department. Of them, there were 15 males and 7 females, aged 21-58 years, 39.2 years old on average; 14 left feet and 8 right feet. A retrospective analysis was conducted to evaluate the pro- and post-operative conditions of treated feet, and the AOFAS mid-foot score and VAS pain score were used to evaluate the functional outcome at the final follow-up time. Result A total of 20 cases were followed up with a mean time of 25 months （14-42 months）. The talar first metatarsal angle and talar second metatarsal angle were significantly improved （P〈0.05） on weight-bearing anterior-posterior X-ray of foot. On the lateral weight-bearing X-ray, the Meary＇s angle was also significantly improved （P〈0.01）, while the talocalcaneal angle was improved with no significant difference. The post-operative AOFAS mid-foot score was significantly improved in comparing with the pre-operative score （30.5±14.9 vs. 81.5±6.3, P〈0.01）, as well as the VAS score （P〈0.01）. One patient was found to be calcaneocuboid joint nonunion, and two patients had skin necrosis, but without deep infection or osteomyelitis. Conclusion Midtarsal arthrodesis significantly improves the alignment of traumatic flatfoot caused by midtarsal fracture dislocation, and also helps to make the foot arch stable, so to relieve the symptoms. However, most of the patients are not able to reach the level in movement as before injury. Early diagnosis and rational treatment are important for the midtarsal injury patients.
出处
《足踝外科电子杂志》
2014年第3期164-168,共5页
Electronic Journal of Foot and Ankle Surgery
关键词
中足损伤
骨折脱位
平足症
关节融合
Midfoot injury
Fracture dislocation
Flatfoot
Arthrodesis
