跟舟联合切除及趾短伸肌肌瓣置入手术治疗症状性跟舟联合的疗效分析

doi:10.3760/cma.j.cn101202-20190912-00286

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摘要目的探讨症状性跟舟联合患者跟舟联合切除及趾短伸肌肌瓣置入的手术疗效。方法回顾性分析2016年2月—2018年3月北京同仁医院足踝外科9例(10足)症状性跟舟联合患者的临床资料。其中男6例、女3例,年龄11~63(平均30.3)岁,骨性联合2足、纤维性联合8足。患者均行跟舟联合切除及趾短伸肌肌瓣置入手术治疗,术后观察有无出现伤口感染、术区疼痛、跟舟联合复发、周围关节退变及足部畸形,比较患者手术前后疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分。结果 9例患者随访17~42个月,平均29.1个月。所有患者症状缓解,未出现伤口感染、复发、周围关节退变及后足力线异常。患者末次随访疼痛VAS为(1.50±0.97)分,较术前(4.30±1.49)分明显降低,差值3(2,3)分,差异有统计学意义(Z=2.859, P＜0.01);末次随访AOFAS评分为(90.40±7.04)分,较术前(77.30±7.66)分明显提高,差值(13.10±5.70)分,差异有统计学意义(t=7.262, P＜0.01)。所有患者对治疗结果表示满意。结论对于症状性跟舟联合患者,保守治疗失败时可行手术治疗,跟舟联合切除后用趾短伸肌肌瓣置入可有效预防跟舟联合的复发,临床疗效肯定。

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	贾二龙
	孙超
	王智
	钱会杰

关键词 ：骨结合, 跟舟联合, 跗骨联合, 外科手术, 骨桥

Abstract：Objective To evaluate the surgical efficacy of coalition resection with extensor digitorum brevis interposition in symptomatic patients with calcaneonavicular coalition.Methods Retrospective study. A total of 9 patients (10 feet) with symptomatic calcaneonavicular coalition were included in the Department of Foot and Ankle Surgery of Beijing Tongren Hospital from February 2016 to March 2018, who underwent calcaneonavicular coalition resection with extensor digitorum brevis interposition, which consisted of 6 males and 3 females with a mean age of 30.3 (range, 11-63) years. Two feet were osseous coalition and the others (8 feet) were fibrous coalition. Observation of surgical effect included: wound infection, pain, coalition recurrence, adjacent joint degeneration, and foot deformities. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were evaluated preoperatively and postoperatively.Results The 9 patients were followed up for 17-42 months, the mean followed-up time was 29.1 months. All patients showed remission of symptoms, no wound infection, coalition recurrence, adjacent joint degeneration or abnormal posterior foot strength line occured. Postoperative VAS (1.50±0.97) at the last follow-up was obviously lower than preoperative VAS (4.30±1.49), with a difference of 3 (2,3), indicating a statistically significant difference (Z=2.859, P<0.01). Postoperative AOFAS score at the last follow-up (90.40±7.04) was obviously higher than preoperative AOFAS score (77.30±7.66), with a difference of (13.10±5.70), indicating a statistically significant difference (t=7.262, P<0.01). All patients were satisfied with the treatment results.Conclusions For symptomatic calcaneonavicular coalition patients, surgical treatment is feasible when conservative treatment fails. After calcaneonavicular coalition resection, extensor digitorum brevis interposition can prevent coalition recurrence and acquire positive surgical efficacy.

Key words： Synostosis Tarsal coalitions Calcaneonavicular coalition Surgical procedures, operative Bone bridge

收稿日期: 2019-09-12

通讯作者: 孙超,Email:sunchao111@sina.com

引用本文:

贾二龙, 孙超, 王智, 钱会杰. 跟舟联合切除及趾短伸肌肌瓣置入手术治疗症状性跟舟联合的疗效分析[J]. 中华解剖与临床杂志, 2020, 25(4): 371-375.
Jia Erlong, Sun Chao, Wang Zhi, Qian Huijie. Analysis of the surgical efficacy of calcaneonavicular coalition resection with extensor digitorum brevis interposition in the symptomatic calcaneonavicular coalition. Chinese Journal of Anatomy and Clinics, 2020, 25(4): 371-375.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190912-00286 或 http://www.cjac.com.cn/CN/Y2020/V25/I4/371

[1]	Kawashima T, Uhthoff HK. Prenatal development around the sustentaculum tali and its relation to talocalcaneal coalitions[J]. J Pediatr Orthop, 1990,10(2): 238-243.
[2]	Zaw H, Calder JD. Tarsal coalitions[J]. Foot Ankle Clin, 2010, 15(2): 349-364. DOI:10.1016/j.fcl.2010.02.003.
[3]	Kernbach KJ. Tarsal coalitions: etiology, diagnosis, imaging, and stigmata[J]. Clin Podiatr Med Surg, 2010, 27(1): 105-117. DOI:10.1016/j.cpm.2009.08.006.
[4]	Clarke DM. Multiple tarsal coalitions in the same foot[J]. J Pediatr Orthop, 1997, 17(6): 777-780.
[5]	Scott AT, Tuten HR. Calcaneonavicular coalition resection with extensor digitorum brevis interposition in adults[J]. Foot Ankle Int, 2007, 28(8): 890-895. DOI:10.3113/FAI.2007.0890.
[6]	Afolayan JO, Dinneen A, Sakellariou A. Tarsal coalitions-what you need to know[J]. Orthopaedics & Trauma, 2016, 30(1): 30-40.
[7]	Swensen SJ, Otsuka NY. Tarsal coalitions—calcaneonavicular coalitions[J]. Foot Ankle Clin, 2015, 20(4): 669-679. DOI:10.1016/j.fcl.2015.08.001.
[8]	Chapman VM. The anteater nose sign[J]. Radiology, 2007, 245(2): 604-605. DOI:10.1148/radiol.2452050010.
[9]	Ridley LJ, Han J, Ridley WE, et al. Talar beak sign: tarsal coalition[J]. J Med Imaging Radiat Oncol, 2018, 62 Suppl 1: 164-165. DOI:10.1111/1754-9485.35_12786.
[10]	Cohen BE, Davis WH, Anderson RB. Success of calcaneonavicular coalition resection in the adult population[J]. Foot Ankle Int, 1996, 17(9): 569-572. DOI:10.1177/107110079601700912.
[11]	Lawrence DA, Rolen MF, Haims AH, et al. Tarsal coalitions: radiographic, CT, and MR imaging findings[J]. HSS J, 2014, 10(2): 153-166. DOI:10.1007/s11420-013-9379-z.
[12]	Emery KH, Bisset GS 3rd, Johnson ND, et al. Tarsal coalition: a blinded comparison of MRI and CT[J]. Pediatr Radiol, 1998, 28(8): 612-616. DOI:10.1007/s002470050430.
[13]	Guignand D, Journeau P, Mainard-Simard L, et al. Child calcaneonavicular coalitions: MRI diagnostic value in a 19-case series[J]. Orthop Traumatol Surg Res, 2011, 97(1): 67-72. DOI:10.1016/j.otsr.2010.09.015.
[14]	Pagenstert GI, Barg A, Leumann AG, et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle[J]. J Bone Joint Surg Br, 2009, 91(9): 1191-1196. DOI:10.1302/0301-620X.91B9.22570.
[15]	Shirley E, Gheorghe R, Neal KM. Results of nonoperative treatment for symptomatic tarsal coalitions[J]. Cureus, 2018, 10(7): e2944. DOI:10.7759/cureus.2944.
[16]	Van Renterghem D, De Ridder K. Resection of calcaneonavicular bar with interposition of extensor digitorum brevis. A questionnaire review[J]. Acta Orthop Belg, 2011, 77(1): 83-87.
[17]	Singh AK, Parsons SW. Arthroscopic resection of calcaneonavicular coalition/malunion via a modified sinus tarsi approach: an early case series[J]. Foot Ankle Surg, 2012, 18(4): 266-269. DOI:10.1016/j.fas.2012.04.002.
[18]	El Shazly O, Abou El Ela AA. Percutaneous resection of calcaneo-navicular coalition with interposition of synthetic graft[J]. Foot (Edinb), 2011, 21(3): 138-141. DOI:10.1016/j.foot.2011.01.013.
[19]	Masquijo J, Allende V, Torres-Gomez A, et al. Fat graft and bone wax interposition provides better functional outcomes and lower reossification rates than extensor digitorum brevis after calcaneonavicular coalition resection[J]. J Pediatr Orthop, 2017, 37(7): e427-e431. DOI:10.1097/BPO.0000000000001061.
[20]	Mubarak SJ, Patel PN, Upasani VV, et al. Calcaneonavicular coalition: treatment by excision and fat graft[J]. J Pediatr Orthop, 2009, 29(5): 418-426. DOI:10.1097/BPO.0b013e3181aa24c0.
[21]	Fuson S, Barrett M. Resectional arthroplasty: treatment for calcaneonavicular coalition[J]. J Foot Ankle Surg, 1998, 37(1): 11-15. DOI:10.1016/s1067-2516(98)80005-7.