Ceccarini P, Rinonapoli G, Gambaracci G, Bisaccia M, Ceccarini A, Caraffa A
Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
Department of Radiodiagnostic, University of Perugia, Italy.
Foot Ankle Surg. 2018 Aug;24(4):359-364. doi: 10.1016/j.fas.2017.04.003. Epub 2017 Apr 14.
To report on the functional, biomechanical, and radiographic results of patients who had undergone arthroereisis plus tensioning of the posterior tibial tendon for flexible flatfoot. The hypothesis is that arthroereisis associated to a tensioning of the posterior tibial tendon give a good correction with great satisfaction in patients with flexible flatfoot in grade IIA.
We evaluated 29 patients (31 feet), mean age of 46.4 years, who had been surgically treated for adult flatfoot grade IIA according to Myerson. Mean follow-up was 34.15 months. For clinical evaluation, the AOFAS hindfoot and VAS-FA scores were used.
Postoperative results showed significant increases in both AOFAS and VAS-FA scores: 54.2-81.9 and 61.5-83.2 points, respectively. For the X-ray parameters, we observed a significant variation in the talo-first metatarsal angle, from 13.8° in pre-op to 7.4° in post-op. In lateral view, Djian Annonier angle was improved from 146.6° to 134.1°. The Meary's angle, compared to an average of 8.8° in pre-operative stage improved to 4.3° in the post-operative stage. Postoperative satisfaction was excellent-good according to 23 patients (79.4%). Pain in the tarsal sinus was reported in 5 out of 31 feet (16.1%) for the first three months after surgery.
Arthroereisis and tensioning of the posterior tibial tendon provided good functional outcomes for patients under 60 years of age having stage IIA flexible flatfoot without arthritic manifestations.
报告接受关节制动术联合胫后肌腱拉紧术治疗柔韧性扁平足患者的功能、生物力学及影像学结果。假设是关节制动术联合胫后肌腱拉紧术能为IIA级柔韧性扁平足患者提供良好的矫正效果且患者满意度高。
我们评估了29例患者（31足），平均年龄46.4岁，这些患者均根据迈尔森标准接受了IIA级成人扁平足的手术治疗。平均随访时间为34.15个月。临床评估采用美国足踝外科协会（AOFAS）后足评分和扁平足视觉模拟评分（VAS-FA）。
术后结果显示AOFAS和VAS-FA评分均显著提高：分别从54.2分提高到81.9分，从61.5分提高到83.2分。对于X线参数，我们观察到距骨-第一跖骨角有显著变化，术前为13.8°，术后为7.4°。在侧位片上，迪扬-阿诺尼耶角从146.6°改善到134.1°。米里角与术前平均8.8°相比，术后改善到4.3°。根据23例患者（79.4%）的反馈，术后满意度为优-良。术后前三个月，31足中有5足（16.1%）报告跗骨窦疼痛。
关节制动术联合胫后肌腱拉紧术为60岁以下无关节炎表现的IIA级柔韧性扁平足患者提供了良好的功能结果。
