改良Kidner手术联合HyProCure治疗副舟骨源性平足症疗效观察

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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.

Key words： modified Kinder surgical subtalar stabilization flatfoot with accessory navicular

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