Abstract:Objective To evaluate the short-term effectiveness of modified Kinder surgical with HyProCure subtalar stabilization in treatment of flatfoot with accessory navicular.Methods Between December 2014 and Octobetr 2016,17 patients (24 feet) with flatfoot related with accessory navicular were treated,which received conservative treatment for more than half a year,but the pain symptoms were not relieved.There were 6 males (8 feet) and 11 females (16 feet) with the average age of 13.5 years (range,11~17 years).The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot function score was (71.7±4.3),the preoperative pain visual analogue scale (VAS) was (5.54±0.93).The preoperative examination showed type Ⅱ accessory navicular,with posterior foot mild valgus deformity.The height of the arch was reduced in varying degrees.All of them received excision of accessory navicular,placement of HyProCure subtalar stabilization and reconstruction of posterior tibial tendon insertion on navicular with anchor.There were percutaneous Achilles tendon lengthening in 8 feet and gastrocnemius lysis in 7 feet and spring ligament tightening surgery in 5 feet.The talar-first metatarsal angle (Meary 's angle) and calcaneus inclination angle (Pitch angle) were measured on the lateral X-ray,and the talonavicular coverage angle (TCA) and talocalcaneal angle(Kite angle) were measured on the frontal,the AOFAS ankle and foot function score and VAS score were used to evaluate the effectiveness.Results Seventeen patients (24 feet) were followed up for 7 to 23 months with an average of 13.6 months.The talar first metatarsal angle and calcaneus inclination angle on the lateral X ray and the talonavicular coverage angle and talocalcaneal angle on the frontal were improved (P<0.05).Compared with preoperation,AOFAS ankle and foot function score and VAS score were significantly improved at last follow-up,the difference were statistically significant(P<0.05).Conclusion The modified Kinder surgical with HyProCure subtalar stabilization is a good choice for the treatment of flatfoot related with accessory navicular,which can effectively correct the flatfoot deformity,recover foot function and induce less complications,but the long-term effectiveness needs further follow-up.
张德祥 1,李跃辉 1,钟晓 1,徐杨博 2,葛建华 2. 改良Kidner手术联合HyProCure治疗副舟骨源性平足症疗效观察[J]. 实用骨科杂志, 2018, 24(6): 505-509.
Zhang Dexiang,Li Yuehui,Zhong Xiao,et al. The Clinical Effect of Modified Kinder Surgery with HyProCure in Treatment of Flatfoot with Accessory Navicular. sygkzz, 2018, 24(6): 505-509.
[1]Kiter E,Günal I,Karatosun V,et al.The relationship between the tibialis posterior tendon and the accessory navicular[J].Ann Anat,2000,182(1):65-68.
[2]祝文刚,王水勋,牛洪华,等.足副舟骨疼痛综合征继发ⅡA 期胫后肌肌腱功能不全的手术治疗[J].中国矫形外科杂志,2012,20(5):406-410.
[3]张存,俞光荣.痛性足副舟骨诊断和治疗进展[J].国际骨科学杂志,2011,32(6):360-363.
[4]Malicky ES,Levine DS,Sangeorzan BJ.Modification of the kinder procedure with fusion of the primary and accessory navicular bones[J].Foot Ankle Int,1999,20(1):53-54.
[5]Graham ME,Jawrani NT,Chikka A.Extraosseous talotarsal stabi-lization using HyProCure in adults:a 5-year retrospective follow-up[J].J Foot Ankle Surg,2012,51(1):23-29.
[6]Saltzman CL,Brandser EA,Berbaum KS,et al.Reliability of standard foot radiographic measurements[J].Foot Ankle Int,1994,15(12):661-665.
[7]Silver RL,de la Garza J,Rang M.The myth of muscle balance.A study of relative strengths and excursions of normal muscles about the foot and ankle[J].J Bone Joint Surg(Br),1985,67(3):432-437.
[8]De Pellegrin M,Moharamzadeh D,Strobl WM,et al.Subtalar extra-articular screw arthroereisis(SESA)for the treatment of flexible flatfoot in children[J].J Child Orthop,2014,8(6):479-487.
[9]Abdelgaid SM.Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures[J].Foot Ankle Surg,2012,18(3):164-179.
[10]Veitch JM.Evaluation of the Kidner procedure in treatment of symptomatic accessory tarsal scaphoid[J].Clin Orthop RelatRes,1978(131):210-213.
[11]Johnson KA,Strom DE.Tibialis posterior tendon dysfunction[J].Clin Orthop,1989(239):196-206.
[12]Myerson MS,Badekas A,Schon LC.Treatment of stage Ⅱposterior tibial tendon deficiency with flexor digitorum longeus tendon transfer and calcaneal osteotomy[J].Foot Ankle Int,2004,25(5):445-450.
[13]Stein BE,Schon LC.Posterior tibial tendon dysfunction in the adult:current concepts[J].Instr Course Lect,2015(64):441-450.
[14]Walters JL,Mendicino SS.The flexible adult flatfoot:anatomy and pathomechanics[J].Clin Podiatr Med Surg,2014,31(3):329-336.
[15]邓银栓,高秋明,甄平,等.副舟骨源性平足症的手术治疗策略[J].中国骨伤,2015,28(2):188-194.
[16]Cha SM,Shin HD,Kim KC,et al.Simple excision vs the Kidner procedure for type 2 accessory navicular associated with flatfoot in pediatricpopulation[J].Foot Ankle Int,2013,34(2):167-172.
[17]Chung JW,Chu IT.Outcome of fusion of a painful accessory navicular to the primary navicular[J].Foot Ankle Int,2009,30(2):106-109.
[18]Maker JM,Cottom JM.Surgical management of stage 2 adult acquired flatfoot[J].Clin Podiatr Med Surg,2014,31(3):381-389.
[19]苏正兵,杨述华,段德宇,等.距下关节制动术治疗儿童柔韧性扁平足的疗效评价[J].中华小儿外科杂志,2014,35(8):611-614.
[20]Campbell ST,Reese KA,Ross SD,et al.Effect of graft shape in lateral column lengthening on tarsal bone position and subtalar and talonavicular contact pressure in a cadaveric flatfoot model[J].Foot Ankle Int,2014,35(11):1200-1208.
[21]Graham ME.Congenital talotarsal joint displacement and pes planovalgus:evaluation,conservative management,and surgical management[J].Clin Podiatr Med Surg,2013,30(4):567-581.
[22]Graham ME,Jawrani NT.Extraosseous talotarsal stabilization devices:a new classification system[J].J Foot Ankle Surg,2012,51(5):613-619.