Tang Kang-lai, Zhou Jian-bo, Yang Hui-feng, Tan Xiao-kang, Xie Mei-ming, Tao Xu, Xu Ge, Xu Jian-zhong
Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Zhonghua Yi Xue Za Zhi. 2010 Sep 7;90(33):2313-6.
To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage IIB and Stage III adult-acquired flatfoot.
The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage IIB adult-acquired flatfoot and 7 cases of stage III adult-acquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ), talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomies to restore their proper alignments. The optimal positioning of hindfoot could be achieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses.
All patients were followed-up with a mean time of 13.2 (6 - 21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2.6 postoperatively (P < 0.01). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied. Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported.
Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage IIB and III adult-acquired flatfoot deformity. It may relieve pains, correct structural deformities and obtain excellent clinical outcomes.
分析截骨三关节融合术治疗IIB期和III期成人获得性平足症的临床疗效。
作者回顾了10例成人获得性平足症患者，其中IIB期成人获得性平足症3例，III期成人获得性平足症7例。采用距下关节（STJ）、距舟关节（TNJ）和跟骰关节（CCJ）截骨的三关节融合术进行治疗。采用内外侧联合切口充分暴露CCJ、STJ和TNJ。然后将CCJ、STJ和TNJ的软骨完全剥脱并截骨以恢复其正常对线。通过克氏针可实现并固定后足的最佳位置。通过足跟跖侧置入2枚7.3 mm空心螺钉固定STJ。然后分别从远端向近端置入2枚4.5 mm空心螺钉固定TNJ和CCJ。临床评估基于美国足踝外科协会（AOFAS）踝-后足评分以及对疼痛、功能、美观和总体满意度的主观评估。影像学评估包括测量距骨-第一跖骨前后角、跟骨外侧角、距骨-第一跖骨外侧角以及评估所有关节融合的愈合时间。
所有患者均获随访，平均随访时间为13.2（6 - 21）个月。AOFAS踝-后足评分平均从术前的39.4±4.4提高至术后的83.7±2.6（P<0.01）。患者在疼痛、功能和美观方面均有主观改善。总体而言，所有患者均满意。影像学检查显示骨愈合率为100%。距骨-第一跖骨前后角、跟骨外侧角和距骨-第一跖骨外侧角均有统计学意义的改善。未报告感染、不愈合等并发症。
截骨三关节融合术是治疗IIB期和III期成人获得性平足畸形的有效方法。它可缓解疼痛、纠正结构畸形并获得优异的临床疗效。
