Silva M G Amila N, Tan Si Heng Sharon, Chong Hwei Chi, Su Hsien Ching David, Singh Inderjeet Rikhraj
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
Yong Loo Lin School of Medicine, Singapore.
Foot Ankle Int. 2015 Feb;36(2):165-71. doi: 10.1177/1071100714556758. Epub 2014 Nov 17.
The prevalence of tibialis posterior tendon dysfunction (PTTD) is estimated to be as high as 3% to 4% in Western populations, and it is one of the most commonly misdiagnosed conditions of the foot and ankle.
Clinical and radiological outcomes were assessed in grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening. The clinical and radiological findings recorded were the SF-36 score on physical function and mental health, midfoot and hindfoot American Orthopaedic Foot and Ankle Society (AOFAS) clinical scores, the midfoot and visual analog pain scores, as well as the radiological measurements of the hindfoot calcaneal pitch, talo-first metatarsal angle, and medial cuneiform height. The time points of assessment were preoperatively, 6 months postoperatively, and 24 months postoperatively by an examiner different from the operating surgeon.
The SF-36 score on physical function (mean difference of 8.7 and 8.2, respectively), AOFAS midfoot score (mean difference of 29.6 and 15.3, respectively), AOFAS ankle-hindfoot score (mean difference of 23.2 and 14.3, respectively), midfoot visual analog pain score (mean difference of 4.0 and 1.2), and the ankle and hindfoot visual analog score (mean difference of 3.6 and 1.6) all had significant reduction from the preoperative to the 24-month postoperative time point (P < .001). Radiologically, there was also correction of the deformity associated with PTTD. The hindfoot calcaneal pitch was corrected from 8.4 degrees to 18.7 degrees. The talo-first metatarsal angle was corrected from 14.0 degrees to 1.3 degrees, and the medial cuneiform height was corrected from 10.3 mm to 20.4 mm at 24 months postoperatively.
Grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening demonstrated statistical significant improvement in hindfoot and midfoot AOFAS scores, SF-36 physical function scores, as well as visual analog scores. The complications were minimal. We advocate the combination of these procedures as being successful for the treatment of grade IIB PTTD. Longer term follow-up is needed to determine if these improvements plateau, improve, or deteriorate.
Level IV, retrospective case series.
据估计，在西方人群中，胫后肌腱功能障碍（PTTD）的患病率高达3%至4%，它是足踝部最常被误诊的病症之一。
对接受跟骨内移截骨术、外侧柱延长术、趾长屈肌转移术和跟腱延长术治疗的IIB级PTTD患者的临床和影像学结果进行评估。记录的临床和影像学结果包括SF-36身体功能和心理健康评分、中足和后足美国矫形足踝协会（AOFAS）临床评分、中足和视觉模拟疼痛评分，以及后足跟骨倾斜度、距骨-第一跖骨角和内侧楔骨高度的影像学测量值。评估时间点为术前、术后6个月和术后24个月，由与手术医生不同的检查者进行评估。
从术前到术后24个月，身体功能方面的SF-36评分（平均差异分别为8.7和8.2）、AOFAS中足评分（平均差异分别为29.6和15.3）、AOFAS踝-后足评分（平均差异分别为23.2和14.3）、中足视觉模拟疼痛评分（平均差异分别为4.0和1.2）以及踝和后足视觉模拟评分（平均差异分别为3.6和1.6）均有显著降低（P <.001）。在影像学上，与PTTD相关的畸形也得到了矫正。术后24个月时，后足跟骨倾斜度从8.4度矫正至18.7度。距骨-第一跖骨角从14.0度矫正至1.3度，内侧楔骨高度从10.3毫米矫正至20.4毫米。
采用跟骨内移截骨术、外侧柱延长术、趾长屈肌转移术和跟腱延长术治疗IIB级PTTD，在中足和后足AOFAS评分、SF-36身体功能评分以及视觉模拟评分方面均有统计学意义上的显著改善。并发症极少。我们主张将这些手术联合应用治疗IIB级PTTD是成功的。需要进行更长时间的随访以确定这些改善是趋于平稳、进一步改善还是恶化。
IV级，回顾性病例系列研究。
