摘要
目的探讨改良Kidner术联合HyProCure跗骨螺钉距下关节制动术治疗儿童柔软性平足症合并疼痛性副舟骨的疗效。方法2017年6月至2019年10月,对中山大学孙逸仙纪念医院的13例(17足)儿童柔软性平足症合并疼痛性副舟骨患者采用HyProCure跗骨螺钉实施距下关节稳定术联合改良Kidner术进行治疗。患者中男5例,女8例,年龄8~13岁,平均11.5岁。术后定期随访,通过临床并发症、足负重正侧位及后足轴位X线片、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分和视觉模拟评分法(visual analogue score,VAS)评分进行术后疗效评定。结果所有患者均获随访,随访时间6~18个月,平均(12.4±6.2)个月,均无围手术期并发症发生。随访期间无1例移除HyProCure。末次随访时,VAS疼痛评分显著改善[(4.3±1.5)分vs(0.9±0.4)分,P<0.05],术后AOFAS踝-后足功能评分显著改善[(48.3±11.1)分vs(96.3±7.9)分,P<0.01]。术前及术后负重位X线片的角度参数对比:前后位距骨第1跖骨角(talar-metarsal angle on anterior-posterial view,TMA ap)[(-10.8°±6.2°)vs(4.3°±3.8°),P<0.01]、侧位距骨第1跖骨角(talar-metarsal angle on lateral view,TMA lat)[(-11.1°±8.0°)vs(10.5°±5.6°),P<0.01]、前后位距骨跟骨角(talar-calcaneal angle on anterior-posterial view,TCA ap)[(28.3°±7.5°)vs(25.5°±3.9°),P<0.01]、侧位距骨跟骨角(talar-calcaneal angle on lateral view,TCA lat)[(53.1°±9.1°)vs(45.6°±6.8°),P<0.01]、跟骨倾斜角(Pitch角)[(13.3°±5.0°)vs(19.7°±4.3°),P<0.05]、跟骨外翻角[(11.4°±1.9°)vs(2.4°±4.5°),P<0.01]。结论改良Kidner术联合HyProCure跗骨螺钉距下关节制动术治疗儿童柔软性平足症合并疼痛性副舟骨,可显著改善患儿的疼痛与平足骨性结构的异常。
Objective To investigate the effect of modified Kidner operation combined with HyProCure tarsal screw subtalal joint stabilization in the treatment of soft flatfoot with painful accessory scaphoid in children.Methods From June 2017 to October 2019,13cases(17 feet)of children with soft flatfoot and painful accessory scaphoid in Sun Yat-sen Memorial Hospital,Sun Yat sen University were treated with HyProCure tarsal screws for subtalar joint stabilization combined with modified Kidner’s operation.There were 5 males and 8 females,aged 8~13 years with an average age of 11.5 years.The patients were followed up regularly after the operation,postoperative efficacy was assessed by clinical complications,X ray of the foot in the front and side position and the axial position of the rear foot,the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function score and visual analog score(VAS).Results All patients were followed up for 6~18 months with an average(12.4±6.2)months,and no perioperative complications.HyProCure was not removed in one case during follow-up.At last follow-up,VAS score improved significantly[(4.3±1.5)points vs(0.9±0.4)points,P<0.05]and postoperative AOFAS ankle-hindfoot function score[(48.3±11.1)points vs(96.3±7.9)points,P<0.01].Comparison of angle parameters of preoperative and postoperative weight-bearing radiographs:talar-metarsal angle on anterior-posterial view(TMA ap)[(-10.8°±6.2°)vs(4.3°±3.8°),P<0.01],talar-metarsal angle on lateral view(TMA lat)[(-11.1°±8.0°)vs(10.5°±5.6°),P<0.01],talar-calcaneal angle on anterior-posterial view(TCA ap)[(28.3°±7.5°)vs(25.5°±3.9°),P<0.01],talar-calcaneal angle on lateral view,TCA lat[(53.1°±9.1°)vs(45.6°±6.8°),P<0.01],calcaneal tilt angle(Pitch angle)[(13.3°±5.0°)vs(19.7°±4.3°),P<0.05],calcaneal valgus angle[(11.4°±1.9°)vs(2.4°±4.5°),P<0.01].Conclusion The modified Kidner operation combined with subtarsal joint stabilization can significantly improve the pain and abnormal bone structure of flat foot in child
作者
刘文宙
马梦君
曾钢
陈彦博
陈宸
宋卫东
Liu Wenzhou;Ma Mengjun;Zeng Gang;Chen Yanbo;Chen Chen;Song Weidong(Orthopaedic Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China;Orthopaedic Surgery,the Eighth Affiliated Hospital,Sun Yat-sen University,Shenzhen 518033,China)
出处
《足踝外科电子杂志》
2022年第3期22-26,共5页
Electronic Journal of Foot and Ankle Surgery
基金
广东省医学科研基金项目(A2021280)
逸仙临床研究培育项目(SYS-Q-202105,SYS-Q-202202)
逸仙科研启航项目(YXQH202202,YXQH202213)。
关键词
扁平足
副舟骨
改良Kidner术
距下关节制动术
flatfoot
accessory navicular bone
modified Kidner operation
subtalar joint stabilization
