Yu Guangrong, Yu Tao, Yang Yunfeng, Li Bing, Zhu Hui, Chen Kai, Zhang Mingzhu, Zhao Youguang
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Nov;28(11):1321-4.
To investigate the effectiveness of double arthrodesis to correct flatfoot deformity with pes valgus.
Between May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated using subtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years (range, 21-78 years), including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stage III, 5 cases at stage II(c); and 1 case had tarsal coalition. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 48.75 ± 3.46 and 6.08 ± 1.14, respectively.
The mean operation time was 85.6 minutes (range, 65-125 minutes). Eleven patients were followed up for 19.4 months on average (range, 13-30 months). All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks (range, 7-18 weeks): no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint (1 case) and at fixation site (1 case), and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36 ± 2.98 and 0.72 ± 0.11 respectively, showing significant differences when compared with preoperative scores (t = 19.946, P = 0.000; t = 16.288, P = 0.000).
Subtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to triple arthrodesis for the correction of flatfoot deformity with pes valgus.
探讨双关节融合术矫正扁平足伴外翻畸形的有效性。
2009年5月至2012年5月，对12例扁平足伴外翻畸形患者采用单一内侧切口入路行距下关节和距舟关节融合术。其中男性5例，女性7例，平均年龄53.3岁（范围21 - 78岁），包括左足5例，右足7例。其中11例存在胫后肌腱功能障碍；6例为Johnson-Strom III期，5例为II(c)期；1例存在跗骨联合。术前美国矫形足踝协会（AOFAS）评分和视觉模拟评分（VAS）分别为48.75±3.46和6.08±1.14。
平均手术时间为85.6分钟（范围65 - 125分钟）。11例患者平均随访19.4个月（范围13 - 3０个月）。所有病例切口均一期愈合，无感染及神经血管损伤并发症。X线片显示平均骨愈合时间为9.8周（范围7 - 18周）：未发生骨不连。未观察到内固定松动或断裂。跟骰关节处疼痛1例，固定部位疼痛1例，经对症治疗后缓解。平均AOFAS评分和VAS评分分别显著提高至81.36±2.98和0.72±0.11，与术前评分比较差异有统计学意义（t = 19.946，P = 0.000；t = 16.288，P = 0.000）。
单一内侧切口入路行距下关节和距舟关节融合术是矫正扁平足伴外翻畸形的三关节融合术有效的替代方法。
