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[欣特曼跟骨延长截骨术治疗柔韧性扁平足的疗效]

[Efficacy of Hintermann calcaneal lengthening osteotomy for flexible flatfoot].

作者信息

Wang Z Y, Zheng G, Chen W, Chen Q, Wang Y J, Li Y Q, Gou X L, Tang K L, Tao X

机构信息

Sports Medicine Center, the First Affiliated Hospital of Army Medical University, Chongqing 400038, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 May 23;103(19):1490-1495. doi: 10.3760/cma.j.cn112137-20221008-02089.

Abstract

To investigate the clinical efficacy of Hintermann osteotomy (H-LCL) for flexible flatfoot. A follow-up study. Clinical data of 30 patients with flexible flatfoot treated with H-LCL operation from January 2020 to December 2021 in Sports Medical Center of the First Affiliated Hospital of Army Medical University were retrospectively analyzed. There were 8 males and 22 females, with a mean age of (39.0±15.2) years. The mean time from symptom onset to the diagnosis[(,)]was 24.0 (5.5, 102.0) months. The functional and imaging scores of the patients before and after the last follow-up were compared to evaluate the clinical efficacy of the operation. The functional scores included American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) of pain, pain interference (PI) and physical function (PF) index in Patient-Reported Outcomes Measurement Information System (PROMIS). And the imaging scores included Meary's angle, calcaneal pitch angle, calcaneal valgus angle and talonavicular coverage angle. The mean operation time was (82.3±24.4) min, and the follow-up periods was (17.9±6.9) months. At the last follow-up, VAS of pain [(, )] decreased from 5 (4, 6) to 2 (1, 2); PI decreased from 59.8±5.0 to 44.6±5.7; AOFAS increased from 65.2±10.0 to 85.8±3.3; PF increased from 50 (48.5,51.0) to 58.5 (54.0, 66.0); Meary's angle (antero-posterior image) decreased from 15.7° (10.1°, 29.2°) to 3.9° (2.6°, 5.3°); Meary's angle (lateral image) decreased from 13.5°±6.8° to 4.4°±2.6°; calcaneal pitch angle increased from 14.0°±3.3° to 18.6°±4.2°; calcaneal valgus angle decreased from 12.6°±7.3° to 4.3°±2.5°; and talonavicular coverage angle decreased from 20.9°±10.7° to 7.7°±5.2°. The up-mentioned parameters were all improved statistically significant at the last follow-up when compared with those before the operation (all <0.05). H-LCL brings a significant improvement of clinical outcome scores and good radiological correction of flatfoot deformities in correcting flexible flatfoot, it conforms to the anatomical characteristics of the subtalar joint.

摘要

探讨Hintermann截骨术(H-LCL)治疗柔韧性扁平足的临床疗效。一项随访研究。回顾性分析2020年1月至2021年12月陆军军医大学第一附属医院运动医学中心采用H-LCL手术治疗的30例柔韧性扁平足患者的临床资料。其中男性8例,女性22例,平均年龄(39.0±15.2)岁。从症状出现到诊断的平均时间[(,)]为24.0(5.5,102.0)个月。比较患者末次随访前后的功能和影像学评分,以评估手术的临床疗效。功能评分包括美国矫形足踝协会(AOFAS)评分、疼痛视觉模拟量表(VAS)、疼痛干扰(PI)以及患者报告结局测量信息系统(PROMIS)中的身体功能(PF)指数。影像学评分包括Meary角、跟骨倾斜角、跟骨外翻角和距舟覆盖角。平均手术时间为(82.3±24.4)分钟,随访时间为(17.9±6.9)个月。在末次随访时,疼痛VAS[(,)]从5(4,6)降至2(1,2);PI从59.8±5.0降至44.6±5.7;AOFAS从65.2±10.0增至85.8±3.3;PF从50(48.5,51.0)增至58.5(54.0,66.0);Meary角(前后位影像)从15.7°(10.1°,29.2°)降至3.9°(2.6°,5.3°);Meary角(侧位影像)从13.5°±6.8°降至4.4°±2.6°;跟骨倾斜角从14.0°±3.3°增至18.6°±4.2°;跟骨外翻角从12.6°±7.3°降至4.3°±2.5°;距舟覆盖角从20.9°±10.7°降至7.7°±5.2°。与手术前相比,上述参数在末次随访时均有统计学意义的改善(均<0.05)。H-LCL在矫正柔韧性扁平足方面能显著改善临床结局评分并实现良好的扁平足畸形放射学矫正,符合距下关节的解剖学特征。

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