López-Capdevila L, Santamaria Fumas A, Dominguez Sevilla A, Rios Ruh J M, Pich Aguilera E, Boo Gustems N, Roman Verdasco J, Gordillo Uribe J, Sales Perez M
Hospital General Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, España.
Hospital General Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 Jan-Feb;64(1):22-27. doi: 10.1016/j.recot.2019.09.004. Epub 2019 Oct 28.
The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle.
This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36).
All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement.
Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.
跟骨背侧楔形截骨术旨在缩短跟骨长度并抬高跟腱附着点，从而降低跟腱附着点处的张力。本研究的目的是评估该截骨术对伴有跟腱附着点病变及高跟骨倾斜角患者的临床和功能效果。
这是一项回顾性研究，纳入18例诊断为跟腱附着点病变的患者，采用跟骨背侧楔形截骨术、楔形切除并用2枚空心螺钉固定进行治疗。术前及术后采用视觉模拟评分法（VAS）、美国足踝外科协会（AOFAS）踝-后足评分、跟腱功能指数-美国版（VISA-A）及患者满意度量表进行评估。分析的影像学参数包括跟骨倾斜角、跟骨长度及福勒-菲利普斯角。进行了统计学分析。平均随访时间为18.3个月（范围14 - 36个月）。
所有患者均报告症状缓解。VAS评分从8.25分改善至2.16分；AOFAS评分从41.5分升至86.5分（P <.05）。术后X线片上跟腱骨刺的存在与临床改善无关。
基于我们呈现的结果，跟骨背侧楔形截骨术可被视为治疗高跟骨倾斜角患者跟腱附着点病变的一种替代手术方法。所有患者症状缓解可能继发于跟腱附着点处张力的降低。
