Harnroongroj Thos, Chuckpaiwong Bavornrit
Orthopedist, Department of Orthopaedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Orthopedist and Associated Professor, Department of Orthopaedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Foot Ankle Surg. 2018 Sep-Oct;57(5):1014-1019. doi: 10.1053/j.jfas.2018.01.008. Epub 2018 May 24.
Numerous surgical techniques for the treatment of Müller-Weiss disease (MWD) have been reported. However, no extensive clinical and radiographic studies of isolated talonavicular arthrodesis and MWD have been reported. The present retrospective cohort study examined the outcomes of isolated talonavicular arthrodesis at 3 to 8 years of follow-up in 16 MWD patients with a collapsed longitudinal arch and at least Maceira stage III. Demographic data, pre- and postoperative visual analog scale (VAS) scores for pain on walking and walking disability, foot and ankle outcome scores (FAOSs), and radiographic parameters were analyzed, with statistical significance at p < .05. A survival analysis was used to determine the median time to union. The mean ± standard deviation pre- and postoperative VAS scores for pain on walking were 7.69 ± 1.62 and 2.19 ± 1.52 and the walking disability scores were 7.06 ± 2.11 and 2.31 ± 1.92, respectively. The pre- and postoperative FAOSs were 48.07 ± 21.50 and 82.27 ± 13.86 for activities of daily living, 30.86 ± 19.70 and 76.17 ± 22.39 for quality of life, and 20.93 ± 22.89 and 51.88 ± 23.66 for sports/recreation, respectively. The median pre- and postoperative FAOSs for the symptoms subscale were 73.22 (range 42.88 to 100.00) and 87.50 (35.71 to 100.00) and for pain were 34.72 (range 8.33 to 72.22) and 88.89 (54.41 to 100.00), respectively. Significant improvements occurred from preoperatively to postoperatively for VAS scores and FAOSs (p < .05). The mean pre- and postoperative calcaneal pitch angles were 11.31° ± 4.35° and 13.81 ± 5.60, significant improvement (p = .016). Improvement was also seen midfoot abduction, with a mean pre- and postoperative anteroposterior Meary's angle of 14.38° ± 10.07° and 9.38° ± 12.21°. The survival analysis showed union was achieved in all patients, with a median time to union of 2 (95% confidence interval 1.03 to 3.00) months. Our data indicate that talonavicular arthrodesis provides satisfactory functional outcomes for MWD patients with a collapsed longitudinal arch.
已有多篇关于治疗米勒 - 魏斯病（MWD）的手术技术的报道。然而，尚未见关于单纯距舟关节融合术与MWD的广泛临床和影像学研究报道。本回顾性队列研究对16例患有纵弓塌陷且至少处于马塞拉（Maceira）III期的MWD患者进行了3至8年的随访，观察单纯距舟关节融合术的疗效。分析了人口统计学数据、术前和术后行走时疼痛的视觉模拟评分（VAS）、行走障碍评分、足踝结局评分（FAOS）以及影像学参数，p < 0.05具有统计学意义。采用生存分析确定愈合的中位时间。术前和术后行走时疼痛的VAS评分均值±标准差分别为7.69±1.62和2.19±1.52，行走障碍评分分别为7.06±2.11和2.31±1.92。术前和术后FAOS中，日常生活活动能力评分分别为48.07±21.50和82.27±13.86，生活质量评分分别为30.86±19.70和76.17±22.39，运动/娱乐评分分别为20.93±22.89和51.88±23.66。术前和术后症状亚量表的FAOS中位值分别为73.22（范围42.88至100.00）和87.50（35.71至100.00），疼痛亚量表的FAOS中位值分别为34.72（范围8.33至72.22）和88.89（54.41至100.00）。从术前到术后，VAS评分和FAOS均有显著改善（p < 0.05）。术前和术后跟骨倾斜角的均值分别为11.31°±4.35°和13.81±5.60，有显著改善（p = 0.016）。中足外展也有改善，术前和术后前后位梅里（Meary）角的均值分别为14.38°±10.07°和9.
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