Thomas R L, Wells B C, Garrison R L, Prada S A
Department of Orthopaedics, University of Arkansas, Little Rock 72205, USA.
Foot Ankle Int. 2001 Feb;22(2):107-19. doi: 10.1177/107110070102200205.
Forty-five patients (49 feet) underwent lateral column lengthening as treatment for painful pes planus. Twenty-five patients (27 feet) were available for both radiographic and clinical evaluation at least one year postoperatively. Of these 25 patients, 10 feet underwent Evans opening wedge osteotomy with tricortical iliac crest bone graft; 17 feet underwent calcaneocuboid distraction arthrodesis utilizing iliac crest bone graft. In addition, both groups underwent debridement of the posterior tibial tendon combined with transfer of the flexor digitorum longus into the navicular for reinforcement. Radiographic results documented marked improvement in all parameters. There was more improvement in the calcaneocuboid fusion group than the osteotomy group, but the difference was not statistically significant. Postoperative AOFAS rating scores averaged 87.9 for the osteotomy group and 80.9 for the distraction arthrodesis group. The difference was not statistically significant. Twenty of 25 patients (83.5%) in both groups were very satisfied. Twenty-four of 25 patients (96%) stated that knowing the final result they would have the same surgery again. Complications were reported for 32 patients (34 feet). Both the Evans opening wedge calcaneal osteotomy and calcaneocuboid distraction arthrodesis offer significant improvement in the radiographic parameters and AOFAS clinical scores for patients with painful, flexible flatfoot deformity. However, the complication rate remains high with both methods, and the rate of nonunion and delayed union with the calcaneocuboid distraction arthrodesis method remains a significant problem with this technique.
45例患者（49足）接受了外侧柱延长术以治疗疼痛性扁平足。25例患者（27足）在术后至少一年可进行影像学和临床评估。在这25例患者中，10足接受了Evans开放楔形截骨术并取自体三面皮质髂嵴骨移植；17足接受了跟骰关节撑开融合术并取自体髂嵴骨移植。此外，两组均进行了胫后肌腱清创术，并将趾长屈肌转移至舟骨以加强。影像学结果显示所有参数均有显著改善。跟骰关节融合组的改善程度大于截骨组，但差异无统计学意义。截骨组术后AOFAS评分平均为87.9分，撑开融合组为80.9分。差异无统计学意义。两组25例患者中有20例（83.5%）非常满意。25例患者中有24例（96%）表示如果知道最终结果，他们会再次接受相同的手术。32例患者（34足）报告了并发症。Evans开放楔形跟骨截骨术和跟骰关节撑开融合术均可使疼痛性柔韧性扁平足畸形患者的影像学参数和AOFAS临床评分得到显著改善。然而，两种方法的并发症发生率仍然很高，跟骰关节撑开融合术的骨不连和延迟愈合率仍然是该技术的一个重大问题。
