Ruffilli Alberto, Traina Francesco, Giannini Sandro, Buda Roberto, Perna Fabrizio, Faldini Cesare
Rizzoli Orthopaedic Institute, via G.C. Pupilli 1, 40136, Bologna, BO, Italy.
Eur J Orthop Surg Traumatol. 2018 Jan;28(1):139-145. doi: 10.1007/s00590-017-2011-z. Epub 2017 Jul 11.
Grade II chronic tibialis posterior tendon dysfunction (PTTD) poses a reconstructive challenge to the orthopaedic surgeon. Aim of this retrospective study is to report the clinical and radiographical results of a case series of 63 patients (102 ft) affected by grade II PTTD who underwent tailored surgical treatment at 10-year mean follow-up.
Sixty-three patients (102 ft) were available for clinical and radiological evaluation and were retrospectively reviewed at a mean follow-up of 125.1 ± 14.9 months. Tibialis posterior (PTT) treatment was based on the pathological anatomy of the degenerated tendon. PTT repair was performed in 53 cases. Flexor digitorum longus transfer was performed in the remaining 49. Associated procedures were represented by medial displacement calcaneal osteotomy (MDCO) and lateral column lengthening (LCL) depending on the main clinical feature of the foot (hindfoot valgus and forefoot abduction, respectively). Patients' evaluation included AOFAS score and radiographic examination with measure of lateral talus-first metatarsal angle (LTFMA) and talo-navicular coverage angle (TNCA).
AOFAS hindfoot score was 89 ± 10 points at final follow-up. Eighty-six per cent of the patients declared to be satisfied or satisfied with minor reservations. An overall statistical significant decrease was observed in both LTFMA and TNCA values. A better TNCA correction was observed in case of associated LCL with respect to MDCO.
Tailored PTT treatment associated with MDCO or LCL seems provide long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction.
II 级慢性胫后肌腱功能障碍（PTTD）给骨科医生带来了重建方面的挑战。本回顾性研究的目的是报告 63 例（102 足）II 级 PTTD 患者的病例系列的临床和影像学结果，这些患者在平均 10 年的随访中接受了定制的手术治疗。
63 例（102 足）患者可进行临床和放射学评估，并在平均 125.1±14.9 个月的随访中进行回顾性分析。胫后肌腱（PTT）治疗基于退变肌腱的病理解剖结构。53 例进行了 PTT 修复。其余 49 例进行了趾长屈肌转移。根据足部的主要临床特征（分别为后足外翻和前足外展），相关手术包括跟骨内侧移位截骨术（MDCO）和外侧柱延长术（LCL）。患者评估包括美国足踝外科协会（AOFAS）评分以及通过测量距骨-第一跖骨外侧角（LTFMA）和距舟覆盖角（TNCA）进行的影像学检查。
我们观察到 4 例失败病例。末次随访时 AOFAS 后足评分为 89±10 分。86%的患者表示满意或基本满意。LTFMA 和 TNCA 值均出现总体统计学上的显著下降。与 MDCO 相比，联合 LCL 时 TNCA 矫正效果更好。
与 MDCO 或 LCL 联合的定制 PTT 治疗似乎能在治疗 II 期胫后肌腱功能障碍时提供长期的疼痛缓解和满意的功能。
