Duan Xiaojun, Yang Liu
Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P. R. China.
J Int Med Res. 2018 Dec;46(12):5322-5330. doi: 10.1177/0300060518810889. Epub 2018 Nov 19.
Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but bony connection usually develops during the patient's late growth period. Isolated cases of talonavicular coalition have rarely been reported. We herein report a case involving an 11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in which the whole formation of the talonavicular coalition was observed with a series of radiographic and magnetic resonance imaging examinations. The pain caused by the talonavicular coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up confirmed that after the formation of talonavicular coalition, the coalition can continue to progress, forming bony talocalcaneal coalition and calcaneocuboid coalition.
跗骨联合是指在两块或多块跗骨之间形成的异常纤维性、软骨性或骨性连接。距跟联合和跟舟联合占所有跗骨联合病例的90%以上。联合在出生时就已存在，但骨性连接通常在患者生长后期形成。孤立性距舟联合病例鲜有报道。我们在此报告一例11岁患者，其存在从软组织到骨性连接的孤立性距舟联合，因踝关节关节炎接受了关节镜治疗。据我们所知，这是首例通过一系列X线和磁共振成像检查观察到距舟联合完整形成过程的病例。距舟联合引起的疼痛通过非手术治疗得以控制，而踝关节关节炎引起的疼痛在踝关节镜检查后得到缓解。术后6年，患者行走30分钟仍无疼痛，对手术效果满意。持续随访证实，距舟联合形成后，联合可继续进展，形成距跟骨联合和跟骰骨联合。
