[切除副舟骨并重建胫后肌腱在舟骨上的附着点治疗与副舟骨相关的扁平足]

[Excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for treatment of flatfoot related with accessory navicular].

作者信息

Cao Honghui, Tang Kanglai, Deng Yinshuan, Tan Xiaokang, Zhou Binghua, Tao Xu, Chen Lei, Chen Qianbo

机构信息

Department of Orthopaedics, the Orthopaedic Surgery Center of Chinese PLA, Southwest Hospital, the Third Military Medical University, Chongqing, 400038, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jun;26(6):686-90.

PMID:22792764

Abstract

OBJECTIVE

To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness.

METHODS

Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 +/- 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor.

RESULTS

All patients got primary wound healing without any complication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain relief at 6 months after surgery and had good appearance of the feet. The AOFAS ankle-midfoot score was 90.4 +/- 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus inclination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P < 0.01).

CONCLUSION

The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

摘要

目的

分析切除副舟骨并重建胫后肌腱在舟骨上的止点治疗与副舟骨相关的扁平足，并评估其疗效。

方法

2006年5月至2011年6月，对33例（40足）与副舟骨相关的扁平足患者进行治疗。其中男性14例（17足），女性19例（23足），平均年龄30.1岁（范围16 - 56岁）。所有患者均为双侧副舟骨；26例为单侧扁平足，7例为双侧扁平足。病程7个月至9年（中位数24个月）。美国足踝外科协会（AOFAS）踝 - 中足评分为47.9±7.3。X线片显示所有患者均为Ⅱ型副舟骨，伴有足弓高度降低和足跟外翻。所有患者均接受了副舟骨切除及用锚钉重建胫后肌腱在舟骨上的止点。

结果

所有患者切口均一期愈合，无任何并发症。30例（36足）患者获随访6 - 54个月，平均23个月。所有患者术后6个月疼痛完全缓解，足部外观良好。末次随访时AOFAS踝 - 中足评分为90.4±2.0，与术前评分比较差异有统计学意义（t = 29.73，P = 0.00）。X线片显示未观察到螺钉松动或断裂。术前与末次随访时足弓高度、跟骨倾斜角、距跟角及距骨 - 第一跖骨角比较差异有统计学意义（P < 0.01）。