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跟骨闭合楔形截骨术与双侧后上突出部切除术治疗Haglund综合征的对比研究

[A comparative study of the calcaneal closing-wedge calcaneal osteotomy versus posterior-superior prominence removal in both sides with Haglund syndrome].

作者信息

Lin C, Ma L, Chen W, Tao X, Yuan C S, Zhou B H, Tang K L

机构信息

Department of Orthopedics, Sports Injuries Institute of Chongqing, Orthopedic Center of PLA, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2017 Sep 19;97(35):2733-2736. doi: 10.3760/cma.j.issn.0376-2491.2017.35.004.

Abstract

To compare the clinical outcome of removal of calcaneal posterior-superior prominence and that of calcaneal closing-wedge osteotomy for Haglund syndrome. From February 2009 to July 2014, 36 patients with Haglund syndrome were included.They were divided into two groups, and each group included 18 patients and underwent removal of calcaneal posterior-superior prominence and calcaneal closing-wedge osteotomy respectively.They were evaluated preoperatively and after 6 , 12 months and 24 months postoperatively by American Orthopedic Foot & Ankle Society (AOFAS) score, VAS score, VISA-A questionnaire and Maryland Foot Score.Fowler-Philip angle and calcaneal posterior slope of the two groups were compared preoperatively and after 6 months.All data were analysis utilizing SPSS 18.0. At six months of follow-up, the weight-bearing lateral X-rays reveals that removal of calcaneal posterior-superior prominence did not change Fowler-Philip angle and calcaneal posterior slope and calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope significantly[from preoperation (56.5±5.4)°, (120.0±1.3)°to postoperation (48.4±4.6)°, (109.0±5.3)°]. At six months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were worse in the wedge calcaneal osteotomy group.At twelve months of follow-up, no significant difference (>0.05)was found between the two groups in terms of VAS score, and Maryland Foot Score, while the AOFAS score, and VISA-A questionnaire in the wedge calcaneal osteotomy group were better than those of posterior-superior prominence removal group.At twenty-four months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were better in the wedge calcaneal osteotomy group (<0.05). Both the two surgical methods are effective for Haglund syndrome.Calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope of calcaneus and its clinical outcome appears better than that removal of calcaneal posterior-superior prominence.

摘要

比较跟骨后上突出部切除术与跟骨闭合楔形截骨术治疗Haglund综合征的临床疗效。2009年2月至2014年7月,纳入36例Haglund综合征患者。将他们分为两组,每组18例,分别接受跟骨后上突出部切除术和跟骨闭合楔形截骨术。术前以及术后6个月、12个月和24个月时,采用美国足踝外科协会(AOFAS)评分、视觉模拟评分(VAS)、VISA - A问卷和马里兰足部评分对患者进行评估。比较两组术前及术后6个月时的Fowler - Philip角和跟骨后倾角。所有数据采用SPSS 18.0进行分析。随访6个月时,负重位外侧X线片显示,跟骨后上突出部切除术未改变Fowler - Philip角和跟骨后倾角,而跟骨闭合楔形截骨术使Fowler - Philip角和跟骨后倾角显著减小[从术前的(56.5±5.4)°、(120.0±1.3)°降至术后的(48.4±4.6)°、(109.0±5.3)°]。随访6个月时,楔形跟骨截骨术组的AOFAS评分、VAS评分、VISA - A问卷评分和马里兰足部评分更差。随访1年时,两组在VAS评分和马里兰足部评分方面无显著差异(>0.05),而楔形跟骨截骨术组的AOFAS评分和VISA - A问卷评分优于后上突出部切除术组。随访2年时,楔形跟骨截骨术组的AOFAS评分、VAS评分、VISA - A问卷评分和马里兰足部评分更好(<0.05)。两种手术方法治疗Haglund综合征均有效。跟骨闭合楔形截骨术减小了跟骨的Fowler - Philip角和跟骨后倾角,其临床疗效似乎优于跟骨后上突出部切除术。

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