个体化手术治疗遗传性运动感觉神经病引起的柔韧性高弓内翻足

目的评估个体化手术方案对于遗传性运动感觉神经病(HMSN)引起的柔韧性高弓内翻足的临床疗效。方法回顾性分析足踝外科2013年4月至2019年3月收治的HMSN柔韧性高弓内翻足患者共17例(26足)的临床资料,患足均采用个体化的软组织手术(松解、延长、转位)与截骨手术(后足、中足和跖骨的截骨术)治疗。测量所有患足术前与末次随访时跟骨倾斜角(Pitch角)、跟骨第1跖骨角(Hibb′s角)、距骨第1跖骨角(Meary′s角)与跟骨内外翻角(CVA角)的变化情况,评估术前与末次随访的Maryland评分,采用李克特量表评价患者主观满意度。结果术后所有患者切口均Ⅰ期愈合,无并发症发生。所有患者均获得完整随访,随访时间13~26(17.2±3.8)个月。末次随访时患足的Pitch角、Hibb′s角、Meary′s角、CVA均较术前改善,差异有统计学意义(P<0.01);末次随访时Maryland评分较术前(88.7±8.2)分vs(67.1±7.9)分]改善,差异有统计学意义(P<0.01)。李克特量表评价非常满意10例(58.8%),满意5例(29.4%),一般2例(11.7%),主观满意率88.2%。结论对于HMSN引起的柔韧性高弓内翻足,及早的采用个体化手术治疗大多可获得满意效果。

Individualized surgical treatment of flexible high arch varus caused by hereditary motor-sensory neuropathy

Objective To evaluate the clinical efficacy of individualized surgical procedures for patients with flexible high arch varus caused by hereditary motor-sensory neuropathy(HMSN).Method The clinical data of 17 patients(26 feet)with HMSN flexible high arch varus who received treatment from April 2013 to March 2019 were retrospectively analyzed.All patients were treated with individualized soft tissue surgery(release,extension,transposition)and osteotomy(osteotomy of hindfoot,midfoot and metatarsal).The changes of pitch angle(Pitch angle),first metatarsal angle(Hibb′s angle),first metatarsal angle(Meary′s angle)and calcaneal varus angle(CVA)of all affected feet were measured before operation and at the last follow-up.Maryland scores was evaluated before operation and at the last follow-up.The patients′subjective satisfaction was evaluated by Likert scale.Results All the incisions were primary healing after operation,and no complications occurred.All patients were followed up for 13 to 26(17.2±3.8)months.At the last follow-up,the Pitch angle,Hibb′s angle,Meary′s angle and CVA%of the affected feet were significantly improved compared with those before operation(P<0.01).At the last follow-up,Maryland score was significantly improved compared with that before operation(88.7±8.2)vs(67.1±7.9),P<0.01].According to Likert scale,10 cases(58.8%)were very satisfied,5 cases(29.4%)were satisfied,2 cases(11.7%)were general,the subjective satisfaction rate was 88.2%.Conclusion Early individualized surgical treatment can obtain satisfactory results for the flexible high arch varus caused by HMSN.