摘要
目的探讨距舟与跟骰双关节融合术治疗Müller-Weiss病的临床疗效。方法回顾性分析自2010-09—2015-05采用距舟与跟骰双关节融合术治疗的13例(13足)Müller-Weiss病。术中用直径4.0 mm无头加压空心螺钉固定距舟关节,可控加压骑缝钉固定跟骰关节。比较手术前后AOFAS评分、Meary角和跟骨倾斜角。结果 13例均获得随访,随访时间平均19(16.0~21.5)个月。随访期间影像学检查显示距下关节与舟楔关节与术前相比无明显退变。所有患足均获得骨性愈合,愈合时间平均14(11~19)周。1例出现切口感染,对症治疗后痊愈。4例自我感觉在不平坦路面行走时中足不适。末次随访时AOFAS评分、Meary角、跟骨倾斜角较术前明显改善,差异有统计学意义(P<0.05)。结论距舟与跟骰双关节融合术可有效缓解Müller-Weiss病引起的中后足症状,矫正平足畸形和后足内翻畸形,尤其适用于跟骰关节有阳性体征的MaceiraⅢ、Ⅳ期患者,但同时也牺牲了中后足的部分活动度,影响了行走时中足的推动作用。
Objective To evaluate the clinical outcomes of the talonavicular and calcaneocuboid arthrodesis for the treatment of Mttller-Weiss disease. Methods From September 2010 t0 May 2015, 13 feet of 13 patients with Mtiller-Weiss disease were treated in our department by talonavicular and caicaneocuboid arthrodesis. Talonavicular joints were fused by compressed hollow screws, and stables were used to fix calcneocuboid joints. The AOFAS score was applied to evaluate the function of hindfoot, while the Meary angle and calcaneal angle were measured to assess the relocation of foot tarsal bones. Results All patients were followed up from 16.0 to 21.5 months （average, 19 months）, during the follow-up period, the subtalar and naviculocuneiform joints were not significantly affected according to the radiographic images. All feet achieved bone fusion with the mean time of 14 weeks （ranged from 11 to 19 weeks）. Four patients complained the uncomfortable feeling when walking on uneven ground, one incision of a patient was infected and healed finally after the symptomatic treatment. There were significant differences between the last follow-up values and the preoperative values in the AOFAS score, Meary angle and calcaneal angle （P 〈0.05）. Conclusion Talonavicular and calcaneocuboid arthrodesis may achieve favorable outcomes in terms of deformity correction, pain relief, and functional restoration, but the part motion of hindfoot is lost, and the function of hindfoot during walking or running is affected, too. We consider this technique as our treatment choice in patients with Maceira stage Ⅲ and stage Ⅳ Mttller-Weiss disease.
出处
《中国骨与关节损伤杂志》
2018年第2期149-152,共4页
Chinese Journal of Bone and Joint Injury
