Qu Fufeng, Cai Jie, Liang Xiaojun, Li Yi, Lu Jun, Ji Weina, Zeng Qiu
Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China.
Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Feb 15;33(2):166-169. doi: 10.7507/1002-1892.201805036.
To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease.
Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment, were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years (range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years (mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was (9.8±2.8)°, calcaneal pitch angle (CPA) on lateral position was (14.7±5.1)°, Meary angle on lateral position was (4.8±2.8)°, and talar 1 meta-tarsal angle (T1MA) on anteroposterior position was (25.0±7.3)°. Preoperative visual analogue scale (VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot score was 58.8±17.6.
All patients were followed up 14-27 months (mean, 22.3 months). Medial numbness and incision infection occurred in 2, 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showing significant differences when compared with preoperative ones ( =8.18, =0.00; =-6.95, =0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was (-2.5±2.7)°, CPA on lateral position was (25.0±5.2) °, Meary angle on lateral position was (2.6±2.1)°, T1MA on anteroposterior position was (8.1±3.8)°. There was no significant difference in Meary Angle between pre- and post-operation ( =1.53, =0.15). And there were significant differences in the hindfoot axis, CPA, and T1MA between pre- and post-operation ( =11.93, =0.00; =-8.89, =0.00; =8.05, =0.00).
For Müller-Weiss disease patients without adjacent joint arthritis, who are ineffective on conservative treatment, the satisfied short-term effectiveness can be obtained when treated by talonavicular joint arthrodesis and calcaneus osteotomy.
探讨距舟关节融合术和跟骨截骨术治疗Müller-Weiss病的短期疗效。
2015年6月至2017年2月，对14例诊断为Müller-Weiss病且保守治疗无效的患者行距舟关节融合术和跟骨截骨术。其中男性3例，女性11例，平均年龄46.2岁（范围35 - 56岁）。根据Maceira分级标准，Ⅲ期5例，Ⅳ期9例。病程4至12年（平均7年）。术前X线片显示所有患者均未伴有相邻关节关节炎。Saltzman位后足轴线为(9.8±2.8)°，侧位跟骨倾斜角（CPA）为(14.7±5.1)°，侧位Meary角为(4.8±2.8)°，前后位距骨第一跖骨角（T1MA）为(25.0±7.3)°。术前视觉模拟评分（VAS）为5.9±1.5，美国矫形足踝协会（AOFAS）踝后足评分为58.8±17.6。
所有患者均获随访14 - 27个月（平均22.3个月）。分别有2例出现内侧麻木和切口感染。其他患者无明显不适。末次随访时，VAS评分为1.6±1.3，AOFAS评分为90.6±2.7，与术前比较差异有统计学意义（=8.18，=0.00；=-6.95，=0.00）。X线片显示距舟关节和跟骨截骨处均达到骨性愈合。Saltzman位后足轴线为(-2.5±2.7)°，侧位CPA为(25.0±5.2)°，侧位Meary角为(2.6±2.1)°，前后位T1MA为(8.1±3.8)°。术前、术后Meary角比较差异无统计学意义（=1.53，=0.15）。术前、术后后足轴线、CPA及T1MA比较差异有统计学意义（=11.93，=0.00；=-8.89，=0.00；=8.05, =0.00）。
对于无相邻关节关节炎且保守治疗无效的Müller-Weiss病患者，距舟关节融合术和跟骨截骨术可获得满意的短期疗效。
