跟骨截骨联合改良Kidner手术治疗副舟骨源性平足症

摘要
图/表
参考文献
相关文章 (1)

全文: PDF (1133 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的通过临床及影像学的结果评估跟骨内移截骨术结合改良Kidner手术治疗副舟骨源性平足症的临床疗效。方法自2014年1月至2015年12月，我科收治19例(25足)经6个月以上保守治疗无效的副舟骨源性平足症患者，其中男7例9足，女12例16足；年龄18～52岁，平均(33.2±9.8)岁。患者均为柔韧性平足，伴有不同程度的平足及跟骨外翻畸形，术中切除副舟骨行胫后肌腱止点带线锚钉重建术。术前及末次随访患足采用Maryland功能评分及VAS疼痛评分评定。术前及随访拍摄足负重正侧位X线片并记录负重侧位X线片跟骨倾斜角(Pitch)、跟距角(Kite)及距骨第1跖骨角(Meary's)；负重正位X线片的距舟覆盖角(TCA)、距骨第1跖骨角(T1M1)的改变。结果术后19例(25足)患者均获随访，随访时间14～36个月，平均随访时间(23.6±7.1)个月。末次随访时患足Maryland功能评分为(92.1±2.1)分，VAS疼痛评分为(0.7±0.9)分，较术前比较差异均有统计学意义(P＜0.01)。术后负重侧位X线片跟骨倾斜角(Pitch)、跟距角(Kite)及距骨第1跖骨角(Meary's)，负重正位X线片的距舟覆盖角(TCA)、距骨第1跖骨角(T1M1)与术前比较，差异均有统计学意义(P＜0.01)。术后患者切口均为Ⅰ期愈合，无内固定相关并发症发生，患者末次随防足部疼痛均消失，平足畸形明显改善。结论采用跟骨内移截骨术结合改良Kidner手术治疗副舟骨源性平足症可有效纠正平足畸形，术后患足功能恢复好，并发症少。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：副舟骨源性平足症, 跟骨内移截骨术, 足部畸形, 改良Kidner手术

Abstract：Objective To evaluate the clinical effect of calcaneal displacement osteotomy combined with modified Kidner operation for treatment of flatfoot related with accessory navicular by clinical and imaging findings.Methods From January 2014 to December 2015，our department treated 19 cases (25 feet)flatfoot related with accessory navicular.There were 7 males (9 feet)，12 females (16 feet)；aged 18 to 52 years with an average age of (33.2±9.8) years.All patients underwent conservative treatment more than 6 months，All the patients were flexible flat foot，with varying degrees of flat feet and calcaneal valgus.The posterior tibial tendon was preformed and reconstructed with a wire anchor.The preoperative and final follow-up were evaluated by the Maryland function score and the VAS pain score.Before and after the operation，the patients underwent weight-bearing anteroposterior and lateral X-ray of foot and recorded the change of calcaneus inclination angle (Pitch)，talocalcaneal angle (Kite) and talar first metatarsal (Meary ' s) angle in lateral X-ray offoot，the Talonavicular coverage angle (TCA) and the talar first metatarsal angle (T1M1) of the weight-bearing anteroposterior x-ray.Results All the patients were followed up.The follow-up time of 14~36 months，the average follow-up time was (23.6±7.1) months.At the final follow-up patients Maryland score was (92.1±2.1) points，VAS pain score was (0.7±0.9)，compared with preoperative were statistically significant (P＜0.01).Postoperative weightbearing lateral radiographs of calcaneus inclination angle，talocalcaneal angle and talar first metatarsal angle，weight-bearing anteroposterior radiograph of the talonavicular coverage angle，talus first metatarsal angle werecompared with those preoperative.The differences were statistically significant (P＜0.01).All incisions were healed without internal fixation related complications.At the final follow-up，the pain of the foot disappeared，and the deformity was significantly improved.Conclusion The medial displacement calcaneal osteotomy combined with modified Kidner surgical for treatment of flatfoot related with accessory navicular can effectively correct the flatfoot deformity，postoperative foot function recovery，with less complications.

Key words： flatfoot related with accessory navicular medial displacement calcaneal osteotomy foot deformity Modified kidner operation

通讯作者: 梁晓军

作者简介: 蔡杰(1990－ )，男，研究生在读，西安医学院，710068。

引用本文:

蔡杰 1，屈福锋 1，徐军奎 2，李毅 2，曾秋 2，姬维娜 2，梁晓军 2*. 跟骨截骨联合改良Kidner手术治疗副舟骨源性平足症[J]. 实用骨科杂志, 2018, 24(11): 991-994.
CaiJie 1，Qu Fufeng 1，Xu Junkui 2，et al. Calcaneal Osteotomy Combined with Modified Kidner Surgery In Treatment of Flat foot with Accessory Navicular. sygkzz, 2018, 24(11): 991-994.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I11/991

［1］Cheong IY，Kang HJ，Ko H，et al.Genetic influence on accessory navicular bone in the foot：a korean twin and family study［J］.Twin Res Hum Genet，2017，20(3)：236-241.
［2］Grogan DP，Gasser SI，Ogden JA.The painful accessory navicular：a clinical and histopathological study［J］.Foot Ankle，1989，10(3)：164-169.
［3］Coskun N，Yuksel M，Cevener M，et al.Incidence of accessory ossicles and sesamoid bones in the feet：a radiographic study of the Turkish subjects［J］.Surg Radiol Anat，2009，31(1)：19-24.
［4］Vaughan P，Singh D.Ongoing pain and deformity after an excision of the accessory navicular［J］.Foot Ankle Clin，2014，19(3)：541-553.
［5］Veitch JM.Evaluation of the Kidner procedure in treatment of symptomatic accessory tarsal scaphoid［J］.Clin Orthop Relat Res，1978 (131)：210-213.
［6］Park H，Hwang JH，Seo JO，et al.The relationship between accessory navicular and flat foot：aradiologic study［J］.J Pediatr Orthop，2015，35(7)：739-745.
［7］Prichasuk S，Sinphurmsukskul O.Kidner procedure for symptomatic accessory navicular and its relation to pes planus［J］.Foot Ankle Int，1995，16(8)：500-503.
［8］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.
［9］曹洪辉，张传志，卢卫忠，等.副舟骨源性平足症发病特点分析［J］.生物骨科材料与临床研究，2015，12(3)：44-46.
［10］Zadek I，Gold AM.The accessory tarsal scaphoid［J］.J Bone Joint Surg(Am)，1948，30(4)：957-968.
［11］Foster JR，McAlister JE，Peterson KS，et al.Union rates and complications of lateral column lengthening using the interposition plating technique：aradiographic and medical record review［J］.J Foot Ankle Surg，2017，56(2)：247-251.
［12］Ellis SJ，Williams BR，Garg R，et al.Incidence of plantar lateral foot pain before and after the use of trial met al wedges in lateral column lengthening［J］.Foot Ankle Int，2011，32(7)：665-673.
［13］Ellis SJ，Yu JC，Johnson AH，et al.Plantar pressures in patients with and without lateral foot pain after lateral column lengthening［J］.J Bone Joint Surg(Am)，2010，92(1)：81-91.
［14］Weinfeld SB.Medial slide calcaneal osteotomy.Technique，patient selection，and results［J］.Foot Ankle Clin，2001，6(1)：89-94.
［15］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.
［16］Kim JR，Park CI，Moon YJ，et al.Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents［J］.J Orthop Surg Res，2014(9)：131.
［17］Garras DN，Hansen PL，Miller AG，et al.Outcome of modified Kidner procedure with subtalar arthroereisis for painful accessory navicular associated with planovalgus deformity［J］.Foot Ankle Int，2012，33(11)：934-939.
［18］Cao HH，Tang KL，Lu WZ，et al.Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular［J］.J Foot Ankle Surg，2014，53(5)：539-543.
［19］Cha SM，Shin HD，Kim KC，et al.Simple excision vs the Kidner procedure for type 2 accessory navicular associated with flatfoot in pediatric population［J］.Foot Ankle Int，2013，34(2)：167-172.
［20］Lee KT，Kim KC，Park YU，et al.Midterm outcome of modified Kidner procedure［J］.Foot Ankle Int，2012，33(2)：122-127.