| 骨与软组织联合手术治疗伴有痛性副舟骨的柔软性平足症 |
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投稿时间：2018-07-23
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| 作者 | Author | 单位 | Address | E-Mail |
| 张宇 |
ZHANG Yu |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
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| 张挥武 |
ZHANG Hui-wu |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
985839846@qqhot.com |
| 李平 |
LI Ping |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
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| 徐善强 |
XU Shan-qiang |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
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| 张文举 |
ZHANG Wen-ju |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
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| 王勇 |
WANG Yong |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichua, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第1期，第77-81页 |
| DOI：10.3969/j.issn.1003-0034.2019.01.017 |
| 基金项目: |
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中文摘要:
目的：探讨骨与软组织联合手术治疗伴有痛性副舟骨的柔软性平足症的短期临床疗效。
方法：自2015年5月至2017年8月，采用骨与软组织联合手术（腓肠肌松解术、跟骨內移截骨、副舟骨切除胫后肌腱止点重建术）治疗16例（16足）伴有痛性副舟骨的柔软性平足症患者，其中男9例（9足），女7例（7足）；年龄22~48（32.0±3.4）岁，病程6~60（28±20）个月。观察患者手术并发症，比较术前及术后12个月距舟覆盖角、距骨第1跖骨角、足弓高度、跟骨倾斜角及跟骨外翻角的变化情况，并于术后12个月时采用疼痛视觉模拟评分（visual analogue score，VAS）及美国足踝外科协会（American Orthopedic Foot and Ankle Society，AOFAS）踝与后足评分进行疼痛缓解程度及功能的评价。
结果：16例患者获得随访，时间13~25（18.4±3.5）个月。术后患者伤口均甲级愈合，未发生伤口感染、骨折不愈合或延迟愈合、内固定断裂或松动等并发症。术后12个月患者足部内侧疼痛消失，运动能力得到恢复。术前负重足侧位X线片足弓高度、跟骨倾斜角、距骨第1跖骨角（21.51±1.20）°、（10.71±1.52）°、（15.61±1.41）°与术后12个月（31.01±1.62）°、（22.12±2.11）°、（5.10±1.20）°比较差异有统计学意义；负重足正位X线片示距舟覆盖角、距骨第1跖骨角（36.12±2.21）°、（13.41±1.51）°与术后12个月（22.12±2.61）°、（4.30±0.91）°比较差异有统计学意义；术前负重跟骨轴位X线片示跟骨外翻角（10.80±1.21）°与术后12个月（3.92±1.81）°比较差异有统计学意义。术后12个月VAS评分较术前明显改善，差异有统计学意义[（1.82±0.56）vs（6.21±2.31），t=2.64，P<0.05]；术后12个月AOFAS评分87.1±4.7较术前51.2±5.6明显提高（t=3.43，P<0.05），其中优12例，良3例，差1例。
结论：采用骨与软组织联合手术即腓肠肌松解术、跟骨內移截骨、副舟骨切除胫后肌腱止点重建术治疗伴有痛性副舟骨的柔软性平足症的患者能够明显缓解足部疼痛，改善足部外观，提高患者足部功能，手术疗效确切。 |
| 【关键词】舟骨 外科手术 扁平足 |
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| Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone |
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ABSTRACT
Objective: To explore short-term clinical effects of bone and soft tissue combined with surgery for the treatment of soft flatfoot accompanied with painful navicular bone.
Methods: From May 2015 to August 2017,16 patients (16 feet) with navicular bone soft flatfoot accompanied with painful navicular bone were treated with bone and soft tissues operation (gastrocnemius release,medial displacement calcaneal osteotomy,and excision of accessory navicular with reconstruction of posterior tibial tendon). Among them,there were 9 males (9 feet) and 7 females (7 feet),aged from 22 to 48 years old with an average of (32.0±3.4) years old. The duration of diseases ranged from 6 months to 5 years with an average of (2.4±1.7) years. The postoperative complications were observed, talocalcaneal angle,the first metatarsal horn of the talus,arch height,angle of inclination and calcaneal valgus before and after operation at 12 months were compared. VAS score and AOFAS score after operation at 12 months were applied to evaluate pain relief and function.
Results: All patients were followed up for an average of (18.4±3.5) months(13~25 months). The incisions of patients were healed at grade A without wound infection,nonunion or delayed union,internal fixation fracture or loosening and other complications. Medial pain of foot was disappeared and motor ability was restored at 12 months after operation. Arch height,angle of inclination and the first metatarsal horn of the talus of lateral X-ray before operation and after operation at 12 months on weight-bearing foot were(21.51±1.20)°vs(31.01±1.62)°,(10.71±1.52)°vs(22.12±2.11)°,(15.61±1.41)°vs(5.10±1.20)°;talocalcaneal angle,the first metatarsal horn of the talus of AP X-ray before operation and after operation at 12 months on weight-bearing foot were (36.12±2.21) ° vs (22.12±2.61)°,(13.41±1.51)°vs(4.30±0.91)°;calcaneal valgus of axial X-ray before operation and after operation at 12 months on weight-bearing foot were (10.80±1.21)°vs(3.92±1.81)°;there were statistical difference in imaging indicators between preoperation and 12 months after operation. VAS score was significantly decreased from (6.21±2.31) before operation to (1.82±0.56) at 12 months after operation (t=2.64,P<0.05). AOFAS score was obviously increased from (51.2±5.6) before operation to (87.1±4.7) at 12 months after operation (t=3.43,P<0.05).
Conclusion: Bone and soft tissue operation (namely,gastrocnemius release,medial displacement calcaneal osteotomy,and excision of accessory navicular with reconstruction of posterior tibial tendon) could obviously relieve foot pain,improve foot appearance and function in patients with navicular bone soft flatfoot complicated with painful navicular bone,and has certain clinical efficacy. |
| KEY WORDS Scaphoid bone Surgical procedures,operative Flatfoot |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张宇,张挥武,李平,徐善强,张文举,王勇.骨与软组织联合手术治疗伴有痛性副舟骨的柔软性平足症[J].中国骨伤,2019,32(1):77~81 |
| 英文格式: | ZHANG Yu,ZHANG Hui-wu,LI Ping,XU Shan-qiang,ZHANG Wen-ju,WANG Yong.Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(1):77~81 |
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