Shi Eric, Weinraub Glenn M
Fellow, Silicon Valley Reconstructive Foot and Ankle Surgery Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
Attending Physician, Kaiser Permanente San Leandro, San Leandro, CA.
J Foot Ankle Surg. 2019 May;58(3):577-580. doi: 10.1053/j.jfas.2018.08.029. Epub 2019 Feb 8.
Few options exist for the treatment of revision and severe cases of end-stage flatfoot deformity. Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. Lateral column lengthening is a powerful procedure performed either with an Evans calcaneal osteotomy or calcaneocuboid distraction arthrodesis that can be used as an adjunct in realigning the flatfoot. We performed a retrospective radiographic review and looked at 11 consecutive cases of patients who underwent hindfoot arthrodesis with a lateral column lengthening procedure. We matched these patients with 11 control patients who underwent isolated medial-approach double arthrodesis. For the patients who underwent a lateral column lengthening procedure, we found a significant improvement in calcaneal inclination angle (p = .001) and greater correction in talar declination angle, cuboid abduction angle, and talocalcaneal angle when compared with the control group. Lateral column lengthening is a useful adjunct to hindfoot arthrodesis in the correction of revision and severe end-stage flatfoot deformity.
对于晚期扁平足畸形的翻修手术和严重病例，治疗选择很少。三关节融合术或内侧入路双关节融合术一直是标准术式，但往往无法充分矫正畸形。外侧柱延长术是一种有效的手术，可通过埃文斯跟骨截骨术或跟骰关节撑开融合术来实施，可作为矫正扁平足的辅助手段。我们进行了一项回顾性影像学研究，观察了11例连续接受后足融合术并伴有外侧柱延长术的患者。我们将这些患者与11例接受单纯内侧入路双关节融合术的对照患者进行匹配。对于接受外侧柱延长术的患者，与对照组相比，我们发现跟骨倾斜角有显著改善（p = 0.001），距骨倾斜角、骰骨外展角和距跟角的矫正程度更大。外侧柱延长术是后足融合术矫正翻修手术和严重晚期扁平足畸形的有用辅助手段。
