Asencio G, Roeland A, Megy B, Bertin R, Fouque E, Leclerc V
Service de Chirurgie Orthopédique et Traumatologique, CHU Gaston Doumergue, Nîmes.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(8):691-701.
Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis as well as a triple arthrodesis.
There were 27 cases of unstable neurological foot, 13 cases of Rhumatoid foot, 7 cases of flat feet and 3 cases of post-trauma arthritis of the talonavicular joint. The procedure was, in all cases, a talonavicular arthrodesis, associated in some cases to a lengthening of the Achilles tendon, tendon transfer and forefoot correction.
50 cases were reviewed with a mean follow-up of 40 months.
There were 18 per cent cases of non-union. This could be explained by 2 technical errors: bad cartilagenous resection of the surfaces and unstable bone fixation. No subtalar mobility was noted in all cases. Only one case had a midtarsal mobility associated to a non-union. 39 feet had a normal heel axation. In most cases functional improvement was significant with a painless gait.
Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis. Non-union could be avoided by a better surgical technique and a cast immobilization of 2 and a half months. The pre-operative deformities should be reduced manually, because isolated fixed valgus and varus can not be corrected by an isolated talonavicular arthrodesis. In conclusion, the indications are: An early valgus deformity of the hindfoot in rhumatoid arthritis. The aim is to avoid a fixed valgus deformity. Neurological induced equino varus deformities specially after stroke and other reducible neurological deformities. Flat foot due to posterior tibialis insufficiency. Isolated arthritis of the talonavicular joint.
通过单纯距舟关节融合术以及三关节融合术均可实现后足稳定。
共有27例神经源性足部不稳患者、13例类风湿性足部患者、7例扁平足患者以及3例距舟关节创伤后关节炎患者。所有病例均采用距舟关节融合术，部分病例联合跟腱延长、肌腱转移及前足矫正术。
对50例患者进行回顾性分析，平均随访40个月。
不愈合病例占18%。这可归因于两个技术失误：关节面软骨切除不当以及骨固定不稳定。所有病例均未发现距下关节活动度。仅1例不愈合病例伴有中跗关节活动度。39只足足跟轴线正常。多数病例功能改善显著，步态无痛。
单纯距舟关节融合术可实现后足稳定。通过改进手术技术及2个半月的石膏固定可避免不愈合。术前畸形应手动矫正，因为单纯距舟关节融合术无法矫正单纯固定性外翻和内翻畸形。总之，手术适应证为：类风湿性关节炎中后足早期外翻畸形。目的是避免固定性外翻畸形。神经源性马蹄内翻畸形，特别是中风后及其他可复位的神经源性畸形。胫后肌功能不全导致的扁平足。单纯距舟关节关节炎。
