[伊文斯外侧延长跟骨截骨术治疗距跟联合伴后足外翻畸形]
[Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity].
作者信息
Shang Lin, Wang Xiangyu, Wang Aiguo, Jia Guanghui, Li Qi, Zhang Xiaolong, Ma Fuqiang, Wang Yalei
机构信息
Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou Henan, 450052, P.R.China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):173-178. doi: 10.7507/1002-1892.201907065.
OBJECTIVE
To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity.
METHODS
Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation.
RESULTS
All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores ( =-23.380, =0.000; =35.218, =0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones ( <0.05), and the CP was significantly higher than preoperative one ( <0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot).
CONCLUSION
For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.
目的
探讨伊文斯外侧延长跟骨截骨术（E-LLCOT）治疗伴有后足外翻畸形的距下关节联合（TCC）的有效性。
方法
2014年1月至2017年10月，10例（13足）伴有后足外翻畸形的TCC患者接受了E-LLCOT手术。其中男性6例（8足），女性4例（5足），年龄13 - 18岁（平均15.8岁）。病程10 - 14个月（平均11.5个月）。足部畸形表现为后足外翻、前足外展和内侧足弓塌陷。疼痛部位：跗骨窦4足，TCC 5足，踝关节4足。在西尔弗斯基德试验中，3例（4足）腓肠肌紧张，7例（9足）跟腱紧张。术前美国矫形足踝协会（AOFAS）踝后足评分为46.54±9.08，行走1公里后的视觉模拟量表（VAS）评分为6.54±0.88。采用AOFAS踝后足评分和VAS评分评估术后足部功能。术后测量距骨 - 第一跖骨角（T1MT）、距舟覆盖角（TCA）、距骨水平角（TH）、跟骨倾斜角（CP）和足跟外翻角（HV）。
结果
所有切口均一期愈合。所有患者均随访12 - 30个月（平均18个月）。末次随访时，AOFAS踝后足评分和VAS评分分别为90.70±6.75和1.85±0.90，与术前评分相比差异有统计学意义（=-23.380，=0.000；=35.218，=0.000）。X线片显示截骨术后2 - 4个月（平均3个月）愈合。末次随访时，T1MT、TCA、TH和HV均显著低于术前（<0.05），CP显著高于术前（<0.05）。随访期间，1例患者（1足）疼痛缓解不明显，1例患者（1足）腓肠神经皮支损伤。
结论
对于伴有严重后足外翻畸形的TCC，E-LLCOT能有效矫正畸形并缓解疼痛。
Zotero 插件