Ross James R, Dobbs Matthew B
Department of Orthopaedic Surgery, Washington University School of Medicine, Euclid Ave, St Louis, MO 63110, USA.
J Pediatr Orthop. 2011 Dec;31(8):e85-8. doi: 10.1097/BPO.0b013e31822cd47f.
Tarsal coalitions between the navicular and the cuneiforms occur infrequently when compared with the more common talocalcaneal and calcaneonavicular coalitions. Isolated cases of navicular-medial cuneiform coalitions have only rarely been reported; however, the diagnosis is likely underrecognized. Conservative management should be pursued initially for symptomatic patients, followed by surgical options for unresponsive cases. The few reports available recommend treatment with navicular-medial cuneiform fusions, but long-term follow-up is not available to assess outcome and it remains unclear whether an isolated arthrodesis of the navicular-medial cuneiform joint will in turn lead to differing biomechanics of adjacent joints. We report a case of a patient with an isolated navicular-medial cuneiform coalition, treated with resection and free-fat interposition rather than arthrodesis. To our knowledge, this is the first case of a navicular-medial cuneiform coalition reported in a patient of North American ancestry. At 2 years postoperatively, she is pain-free with all activities and has full range of motion of her ankle and subtalar joints, and full mobility at the navicular-medial cuneiform joint. This unique method provided a successful solution to this difficult situation.
与更常见的距下关节和跟舟关节联合相比，舟骨与楔骨之间的跗骨联合并不常见。孤立性舟骨-内侧楔骨联合的病例鲜有报道；然而，其诊断可能未得到充分认识。对于有症状的患者，最初应采取保守治疗，对于无反应的病例则采取手术治疗。现有的少数报告推荐采用舟骨-内侧楔骨融合术进行治疗，但尚无长期随访来评估疗效，而且孤立性舟骨-内侧楔骨关节融合术是否会反过来导致相邻关节生物力学改变仍不清楚。我们报告了一例孤立性舟骨-内侧楔骨联合患者，采用切除术和游离脂肪植入而非关节融合术进行治疗。据我们所知，这是北美血统患者中首例报道的舟骨-内侧楔骨联合病例。术后2年，她在所有活动中均无疼痛，踝关节和距下关节活动范围正常，舟骨-内侧楔骨关节活动自如。这种独特的方法为这一难题提供了成功的解决方案。
