Bolt Patrick M, Coy Samuel, Toolan Brian C
Department of Surgery, University of Chicago Medical Center, IL, USA.
Foot Ankle Int. 2007 Nov;28(11):1115-23. doi: 10.3113/FAI.2007.1115.
This study compared the effects of lateral column lengthening and medial translational calcaneal osteotomy on pedal realignment and degeneration of adjacent hindfoot joints noted on radiographs.
Forty patients who had either a lateral column lengthening (25 feet) or calcaneal osteotomy (17 feet) to reconstruct a flatfoot were retrospectively reviewed as two groups. Six parameters of foot alignment were measured from weightbearing preoperative, early postoperative, and latest followup radiographs. The magnitude of realignment achieved initially and preserved at latest followup was determined for each group. The talonavicular and subtalar joints were graded for radiographic evidence of arthritis before the reconstruction and at latest followup. Demographic information, complication rate, and reoperation associated with each group also were determined by chart review.
The group that received a lateral column lengthening demonstrated a greater initial realignment than the group treated with a calcaneal osteotomy. The lengthening group also demonstrated greater realignment than the osteotomized group when they were compared at their respective latest followup. The lengthening group had a higher number of adjacent joints with progression of arthritis. The rate of nonunion was higher with a lateral column lengthening; however, the rate of reoperation after an osteotomy was more than twice that observed after a lateral column lengthening.
The lateral column lengthening group achieved greater realignment initially and maintained correction better over time than the calcaneal osteotomy group while having a lower reoperation rate despite a higher incidence of nonunion and radiographic progression of adjacent joint arthritis.
本研究比较了外侧柱延长术和跟骨内侧平移截骨术对足部重新排列以及X线片显示的相邻后足关节退变的影响。
将40例行外侧柱延长术（25足）或跟骨截骨术（17足）以重建扁平足的患者回顾性分为两组。从术前负重、术后早期和最新随访的X线片中测量足部排列的六个参数。确定每组最初实现并在最新随访时保留的重新排列幅度。在重建前和最新随访时，对距舟关节和距下关节进行关节炎X线证据分级。还通过病历审查确定每组的人口统计学信息、并发症发生率和再次手术情况。
接受外侧柱延长术的组比接受跟骨截骨术的组表现出更大的初始重新排列。在各自的最新随访中比较时，延长组也比截骨组表现出更大的重新排列。延长组中关节炎进展的相邻关节数量更多。外侧柱延长术的骨不连发生率更高；然而，截骨术后的再次手术率是外侧柱延长术后观察到的再次手术率的两倍多。
外侧柱延长术组最初实现了更大的重新排列，并且随着时间的推移比跟骨截骨术组更好地维持了矫正效果，尽管骨不连发生率较高且相邻关节关节炎有X线进展，但再次手术率较低。
