Feng Pin, Li Jia, Ouyang Xiangyu, Gao Feng, Zhang Hui
Department of Orthopedics, Tibetan Chengdu Office Branch Hospital of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Department of Orthopedics, West China Hospital, Sichuan University.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Aug 8;30(8):975-979. doi: 10.7507/1002-1892.20160198.
To evaluate the short-term effectiveness of Hyprocure subtalar stabilization for adolescent flexible flatfoot.
Between December 2013 and September 2015, 14 cases (26 feet) of adolescent flexible flatfoot were treated with Hyprocure subtalar stabilization. There were 10 males (18 feet) and 4 females (8 feet) with the average age of 14.5 years (range, 12-18 years). There were 12 cases (24 feet) of congenital flatfoot and 2 cases (2 feet) of flatfoot caused by neurological diseases. The preoperative pain visual analogue scale (VAS) was 4.2±0.4; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot function score was 72.2±12.3. Simple Hyprocure subtalar stabilization was used in 8 feet, and a combination of minimally invasive percutaneous Achilles tendon lengthening or gastrocnemius lysis, preposing of posterior tibial tendon and spring ligament tightening surgery, or open dorsal medial cuneiform osteotomy and bone graft in 18 feet. The VAS score and AOFAS ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (T1MT), the talus-the second metatarsal angle (T2MT), and talonavicular coverage angle (TCA) were measured on the anteroposterior X-ray film; the Meary's angle, calcaneal inclination angle (CI), and the talar declination (TD) were measured on the lateral X-ray film.
All incisions healed well. Two cases (2 feet) had tarsal sinus pain, which was cured after symptomatic treatment. All patients were followed up 5-24 months (mean, 14.5 months). Pain was obviously relieved. At last follow-up, VAS score was significantly decreased to 1.4±0.3 (=27.676, =0.000). AOFAS ankle and foot function score was significantly increased to 94.5±10.8 (=7.765, =0.000). The postoperative X-ray film showed that medial arch was elevated after the Hyprocure subtalar stabilization was placed in tarsal sinus. At last follow-up, the T1MT, T2MT, TCA, Meary's angle, and TD were significantly improved when compared with preoperative ones (<0.05); CI has no significant improvement (=0.109, =0.598).
Hyprocure subtalar stabilization is simple, effective for adolescent flexible flatfoot, the short-term effectiveness is good. But the indications should be strictly controlled, treatment should be individualized, corresponding auxiliary soft tissue and bone surgery is needed. The long-term effectiveness needs further follow-up.
评估Hyprocure距下关节稳定术治疗青少年柔韧性扁平足的短期疗效。
2013年12月至2015年9月，对14例（26足）青少年柔韧性扁平足患者行Hyprocure距下关节稳定术。其中男性10例（18足），女性4例（8足），平均年龄14.5岁（12 - 18岁）。先天性扁平足12例（24足），神经疾病所致扁平足2例（2足）。术前疼痛视觉模拟评分（VAS）为4.2±0.4；美国矫形足踝协会（AOFAS）踝与足功能评分为72.2±12.3。单纯Hyprocure距下关节稳定术8足，18足采用微创经皮跟腱延长或腓肠肌松解、胫后肌腱前置及弹簧韧带紧缩术，或开放内侧楔骨背侧截骨植骨术联合应用。采用VAS评分及AOFAS踝与足功能评分评估疗效。在前后位X线片上测量距骨 - 第一跖骨角（T1MT）、距骨 - 第二跖骨角（T2MT）及距舟覆盖角（TCA）；在侧位X线片上测量Meary角、跟骨倾斜角（CI）及距骨倾斜度（TD）。
所有切口愈合良好。2例（2足）出现跗骨窦疼痛，经对症治疗后治愈。所有患者随访5 - 24个月（平均14.5个月）。疼痛明显缓解。末次随访时，VAS评分显著降至1.4±0.3（t = –27.676，P = 0.000）。AOFAS踝与足功能评分显著升至94.5±10.8（t = 7.765，P = 0.000）。术后X线片显示，将Hyprocure距下关节稳定器置于跗骨窦后内侧足弓抬高。末次随访时，与术前相比，T1MT、T2MT、TCA、Meary角及TD均显著改善（P < 0.05）；CI无显著改善（t = 0.109，P = 0.598）。
Hyprocure距下关节稳定术治疗青少年柔韧性扁平足操作简单、有效，短期疗效良好。但应严格掌握适应证，个体化治疗，必要时联合相应的辅助软组织及骨手术。长期疗效有待进一步随访观察。
