Burrus M Tyrrell, Werner Brian C, Carr James B, Perumal Venkat, Park Joseph S
Resident Physician, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
Resident Physician, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
J Foot Ankle Surg. 2016 Nov-Dec;55(6):1169-1174. doi: 10.1053/j.jfas.2016.07.001. Epub 2016 Sep 7.
For rigid pes planovalgus deformities, modified double and triple arthrodeses have had high union rates and subjective outcomes reported. Increased rates of talonavicular nonunions after modified double arthrodesis have led to concern regarding this procedure. A retrospective medical record review was performed of patients who had undergone either a modified double (n = 9) or triple (n = 7) arthrodesis for stage 3 pes planovalgus deformity. Radiographs were reviewed for hindfoot alignment, bony union, and hardware failure. Data from questionnaires, including the Foot and Ankle Ability Measure and the Foot and Ankle Outcome Score, were obtained. No significant differences were found between the cohorts in terms of preoperative radiographic parameters or patient characteristics. The modified double arthrodesis cohort demonstrated a nonunion rate of 44% (4 of 9), but the triple arthrodesis cohort had a 0% (0 of 7) nonunion rate (p = .042). The Foot and Ankle Ability Measure activities of daily living, Foot and Ankle Outcome Score activities of daily living, and Foot and Ankle Outcome Score quality of life scores were significantly worse for the modified double arthrodesis than for the triple arthrodesis group. For patients with stage 3 pes planovalgus, modified double arthrodesis resulted in significantly greater rates of nonunion and incomplete union, with significantly inferior subjective outcome scores compared with triple arthrodesis for the same indication.
对于僵硬性平足外翻畸形，改良双关节和三关节融合术的骨愈合率较高，且有相关主观疗效报道。改良双关节融合术后距舟关节不愈合率增加，引发了对该手术的担忧。对因Ⅲ期平足外翻畸形接受改良双关节融合术（n = 9）或三关节融合术（n = 7）的患者进行了回顾性病历审查。复查了X线片以评估后足对线、骨愈合及内固定失败情况。获取了包括足踝功能测量量表和足踝结局评分在内的问卷调查数据。两组患者术前影像学参数或患者特征方面未发现显著差异。改良双关节融合术组的不愈合率为44%（9例中的4例），而三关节融合术组的不愈合率为0%（7例中的0例）（p = 0.042）。改良双关节融合术组的足踝功能测量量表日常生活活动评分、足踝结局评分日常生活活动评分及足踝结局评分生活质量评分均显著低于三关节融合术组。对于Ⅲ期平足外翻患者，改良双关节融合术导致的不愈合和骨不连发生率显著更高，与相同适应证的三关节融合术相比，主观结局评分明显更低。
