Myerson Mark S, Badekas Athanasios, Schon Lew C
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD, USA.
Foot Ankle Int. 2004 Jul;25(7):445-50. doi: 10.1177/107110070402500701.
To assess the efficacy of surgical correction of stage II tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular, the authors retrospectively reviewed results of treatment of stage II posterior tibial tendon deficiency in 129 patients for whom surgery was performed between 1990 and 1997.
The indication for surgery included tendon weakness, flexible deformity, and foot pain refractory to nonsurgical treatment. All patients had a painful flexible flatfoot without fixed forefoot supination deformity (stage II). A medial translational osteotomy of the calcaneus and transfer of the flexor digitorum longus tendon into the navicular were done. The patients were examined, radiographs were obtained, and isokinetic evaluation of both feet was performed at a mean of 5.2 years postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and Short Form Health Surgery (SF-36) were used to evaluate patients postoperatively.
The mean AOFAS score at follow-up was 79 points (range, 54-93). There were seven significant complications in six patients. Isokinetic inversion and plantarflexion power and strength were symmetric with the contralateral limb in 95 patients, mildly weak in 18 patients, and moderately weak in eight patients. Subtalar joint motion was normal in 56 (44%), slightly decreased in 66 (51%), and moderately decreased in seven patients (5%). Correction was significant (p < .05) in all four radiographic parameters evaluated. Patients were entirely satisfied (118 patients), partially satisfied (seven patients), or dissatisfied (four patients). Further, 125 (97%) experienced pain relief, 121 (94%) showed improvement of function, 112 (87%) experienced improvement in the arch of the foot, and 108 (84%) were able to wear shoes comfortably without shoe modifications or orthotic arch support.
The surgical correction of stage II posterior tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular yielded excellent results with minimal complications and a high patient satisfaction rate.
为评估采用跟骨内侧平移截骨术及趾长屈肌腱转位至舟骨治疗Ⅱ期胫后肌腱缺损的手术疗效，作者回顾性分析了1990年至1997年间接受手术治疗的129例Ⅱ期胫后肌腱缺损患者的治疗结果。
手术指征包括肌腱无力、柔韧性畸形以及非手术治疗无效的足部疼痛。所有患者均患有疼痛性柔韧性扁平足，无前足固定内旋畸形（Ⅱ期）。实施了跟骨内侧平移截骨术，并将趾长屈肌腱转位至舟骨。对患者进行检查，拍摄X线片，并在术后平均5.2年时对双足进行等速肌力评估。采用美国矫形足踝协会（AOFAS）后足评分量表和健康调查简表（SF-36）对患者术后情况进行评估。
随访时AOFAS平均评分为79分（范围为54 - 93分）。6例患者出现7项严重并发症。95例患者的等速内翻和跖屈力量与对侧肢体对称，18例患者轻度减弱，8例患者中度减弱。距下关节活动度正常的有56例（44%），轻度降低的有66例（51%），中度降低的有7例（5%）。在评估的所有四项X线参数中，矫正效果显著（p < 0.05）。患者完全满意的有118例，部分满意的有7例，不满意的有4例。此外，125例（97%）疼痛缓解，121例（94%）功能改善，112例（87%）足弓改善，108例（84%）无需修改鞋子或使用矫形足弓支撑就能舒适地穿鞋。
采用跟骨内侧平移截骨术及趾长屈肌腱转位至舟骨治疗Ⅱ期胫后肌腱缺损，手术效果极佳，并发症极少，患者满意度高。
