Zhou Jian-bo, Tang Kang-lai, Yang Hui-feng, Tao Xu, Xie Mei-ming, Li Hui, Tan Xiao-kang, Xu Jian-zhong
Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Zhonghua Yi Xue Za Zhi. 2010 Sep 7;90(33):2320-3.
To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction.
From 2005 to 2009, 10 patients (13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteotomy with mini-incision. The lateral skin incision of 3.0 - 4.5cm was made to explore the lateral calcaneal wall. Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3-1/2 width of calcaneal body and fixed by two parallel cannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI), talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot.
With a mean postoperative follow-up period of 20.3 months (range 7 - 55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50.3 to a mean of 80.2 at 6 months and a mean of 84.2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P < 0.001), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view.
The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.
探讨小切口跟骨内移截骨术治疗胫后肌腱功能不全所致后天性柔韧性扁平足的临床疗效。
2005年至2009年，对10例（13足）足跟外翻明显的后天性柔韧性扁平足患者行小切口跟骨内移截骨术。做3.0 - 4.5cm的外侧皮肤切口，显露跟骨外侧壁。从跟骨体的下外侧向上内侧垂直于跟骨体长轴进行截骨。将远侧骨段向内移位跟骨体宽度的1/3 - 1/2，并用两根平行的空心螺钉固定。所有患者在术后6周、3个月、6个月、12个月以及术前和术后每6个月进行临床检查和影像学研究评估。所有患者均采用扩展问卷协议和AOFAS踝与后足评分量表进行体格检查。全足侧位片可评估骨愈合情况、跟骨倾斜角（CI）、距跟角（TC）和距骨第一跖骨角（TMT）。全足正位片可评估TC和TMT。通过后足轴位X线片可评估足跟内翻/外翻对线情况。
术后平均随访20.3个月（范围7 - 55个月），经临床检查和影像学证实所有患者均骨愈合。AOFAS评分量表从术前平均50.3分提高到术后6个月平均80.2分，末次随访时平均84.2分，无感染、神经损伤等并发症。所有影像学参数差异均有统计学意义（P < 0.001），包括侧位片上的CI、TC和TMT以及正位片上的TC和TMT。轴位片上足跟内翻/外翻得到矫正。
小切口跟骨内移截骨术是治疗后天性柔韧性扁平足的推荐术式，临床疗效优良，可矫正畸形且并发症较少。
