摘要
目的 比较分析距下关节制动术(subtalar arthroereisis,STA)联合改良Kidner术与单纯STA治疗儿童柔韧性平足合并痛性副舟骨的临床疗效。方法 回顾分析2018年8月—2021年8月收治且符合选择标准的33例柔韧性平足合并痛性副舟骨患儿临床资料。根据手术方式分为联合组(17例,行STA联合改良Kidner术)和对照组(16例,单纯行STA)。两组患儿性别、年龄、侧别、病程及术前疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)踝与后足评分、距骨-第1跖骨角(talus-first metatarsal angle,T1MT)、距骨-第2跖骨角(talus-second metatarsal angle,T2MT)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)、跟骨外翻角(heel valgus angle,HV)等基线资料比较差异均无统计学意义(P>0.05)。记录两组手术时间、切口长度、术中出血量、术中透视次数及围术期并发症;定期复查患足正侧位及轴位X线片并测量T1MT、T2MT、TCA、Meary角、Pitch角、HV;手术前后采用VAS评分、AOFAS踝与后足评分评价疼痛及功能恢复情况。结果 两组患儿均顺利完成手术,无血管、神经、肌腱损伤等手术并发症发生。对照组手术时间、切口长度、术中出血量及术中透视次数均明显优于联合组(P<0.05)。联合组1例患儿切口边缘处皮肤出现部分坏死,予以换药、烤灯照射等处理后愈合;其余切口均Ⅰ期愈合。所有患儿均获随访,随访时间12~36个月,平均19.6个月。末次随访时,两组VAS评分、AOFAS踝与后足评分均较术前显著改善(P<0.05),联合组上述评分手术前后差值优于对照组(P<0.05)。影像学检测示,末次随访两组T1MT、T2MT、TCA、Meary角、HV均较术前显著改善(P<0.05),Pitch角与术前比较差异无统计学意义(P>0.05);但两组间手术前后差值比较差异均无统计学意义(P>0.05)。结论 两种术式均能有效治疗儿童柔韧性平足合并痛性副舟骨,单纯STA�
Objective To compare the effectiveness of subtalar arthroereisis(STA)combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children.Methods The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed.They were divided into a combination group(17 cases,treated by STA combined with modified Kidner procedure)and a control group(16 cases,treated by STA alone)according to the surgical methods.There was no significant difference in baseline data between the two groups(P>0.05),such as gender,age,affected side of the foot,disease duration,and preoperative visual analogue scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,talus-first metatarsal angle(T1MT),talus-second metatarsal angle(T2MT),talonavicular coverage angle(TCA),talus first plantar angle(Meary angle),calcaneal inclination angle(Pitch angle),and heel valgus angle(HV).The operation time,incision length,intraoperative blood loss,number of intraoperative fluoroscopies,and perioperative complications were recorded in both groups.The anteroposterior,lateral,and calcaneal axial X-ray films for the affected feet were taken regularly,and T1MT,T2MT,TCA,Meary angle,Pitch angle,and HV were measured.The VAS score,AOFAS anklehindfoot score were used to evaluate pain and functional recovery before and after operation.Results Surgeries in both groups were successfully performed without surgical complication such as vascular,nerve,or tendon injuries.Less operation time,shorter incision length,less intraoperative blood loss,and fewer intraoperative fluoroscopies were found in the control group than in the combination group(P<0.05).One case in the combination group had partial necrosis of the skin at the edge of the incision,which healed after the dressing change and infrared light therapy,and the
作者
邓明明
孙广超
杜瑞
付炳金
赵永杰
尹刚
刘颖
DENG Mingming;SUN Guangchao;DU Rui;FU Bingjin;ZHAO Yongjie;YIN Gang;LIU Ying(Department of Foot and Ankle Surgery,Affiliated Hospital of Binzhou Medical University,Binzhou Shandong,256603,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第10期1225-1229,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
柔韧性平足
副舟骨
距下关节制动术
改良Kidner术
儿童
Flexible flatfoot
accessory navicular bone
subtalar arthroereisis
modified Kidner procedure
children
