跟骨内移截骨治疗获得性扁平足临床分析

[目的]探讨跟骨内移截骨治疗扁平足的要点及临床疗效.[方法]自2006年1月～2009年12月,采取跟骨内移截骨及联合手术治疗扁平足3l例,男17例,女14例;年龄19～50岁(平均26.7岁).术前均摄足侧位及跟骨轴位X线片及跟骨CT,测量第1跖距角5°～32°(平均22.3°).均有跟腱挛缩、外移、跟骨外翻、前足旋前外展(负重位外观),有疼痛,根据美国矫形足踝协会(AOFAS)踝后足评分标准评分平均45.8分.胫后肌腱功能不全均二级.单纯跟骨内移截骨13例,跟骨内移截骨加跟腱延长4例,跟骨内移截骨加跟腱延长及趾长屈肌腱移位14例.[结果]术后随访6～26个月(平均18.8个月),内侧纵弓较手术前增加,内侧柱高度由术前(8.5±3.2)mm增至(16.3±4.1)mm(t=8.35,P≤0.001),10例疼痛消失,15例减轻,6例无明显改变.第1跖距角由术前5°～32°(平均22.3°±4.5°)降至0°～7°(平均3.2°±1.4°) (t=22.57,P≤0.001).足外翻及外展明显改善,有效率80.6%(25/31),(AOFAS)踝后足评分平均84.5分.[结论]跟骨体部截骨手术治疗可屈性平足疗,能够可靠地纠正平足症的跟骨外翻畸形,部分恢复其内侧纵弓,改善足的负重和足踝部生物力学特性,术中根据情况联合其他术式提高疗效,同时应严格掌握适应证.     

跟骨内移截骨术在平足症治疗中的应用

扁平足是足部常见畸形,出现症状者为平足症,表现为足踝部疼痛、行走无力,久之可影响整个下肢和脊柱.目前平足症的治疗仍是一个棘手的问题,国内主要采用保守治疗.国外已经倾向于手术治疗,并报道多种手术方法,其中跟骨内移截骨术(medial displacement calcaneal osteotomy,MDCO)及其联合手术在临床上应用广泛,效果肯定,现综述如下.     

骨盆内移截骨术治疗成人髋臼发育不良

成人髋臼发育不良基本病变是髋臼过浅，倾斜度过大，头臼包容不佳，是造成继发性髋关节骨关节炎的常见原因。骨盆内移截骨术是通过对髋关节生物力线的调整和增加头臼包容为基础。我们自１９９４年以来，对１０例成人髋臼发育不良施行手术，取得良好的效果。１临床资料一般...     

骨盆内移截骨术治疗成人期髋关节半脱位

骨盆内移截骨术治疗儿童先天性髋关节脱位国内报道不少 ,但利用该手术治疗成人期髋关节半脱位国内尚未见报道。我科自 1986年 6月～ 1996年 10月间采用骨盆内移截骨术治疗成人期髋关节半脱位 12例 ,全部进行随访 ,发现该手术不但解决了髋关节覆盖问题 ,且髋关节功能良好 ,效果满意。1　临床资料本组成人髋关节半脱位 12例 ,12个髋 ;其中男 2例 ,女10例 ;年龄最小 18岁 ,最大 42岁 ,平均 2 9岁。按照Ｃｒｏｗｅ等[1] 方法对髋臼发育不良进行分期 :Ⅰ期脱位 5 0 %以下 ,8髋 ;Ⅱ期脱位 5 0 %～ 70 % ,3髋 ;Ⅲ期脱位 75 %～ 99% ,1髋。髋臼指数…     

跟骨截骨术治疗陈旧性跟骨骨折畸形愈合

跟骨截骨术治疗陈旧性跟骨骨折畸形愈合雷云山，雷晓晶，雷晓宇，陈林山作者自１９６４年以来治疗跟骨骨折畸形愈合１９例（２８足），获得较好的治疗效果。１临床资料本组男１６例２４足，女３例４足，共１９例２８足，单足１０例，双足９例，均为青壮年。原因：高处坠落...     

骨盆内移截骨术治疗大龄儿童先天性髋脱位28例

目的:分析骨盆内移截骨术治疗大龄儿童先天性髋脱位的疗效。方法:先天性髋脱位28例,男10例,女18例;年龄6~13岁,平均8.9岁;左侧9例,右侧19例。均为外上方脱位。X线检查:股骨头髋臼比例不协调,髋臼浅,股骨头大,髋臼指数大于50°。均采用骨盆内移截骨术。结果:术后获得2~12年的随访,平均5年3个月。患者髋部疼痛、活动度及跛行均有明显改善。股骨头缺血性坏死3例,晚期发生半脱位1例,根据先天性髋脱位疗效评定标准:优14例,良10例,可3例,差1例。结论:Ch iari骨盆内移截骨术治疗大龄儿童先天性髋脱位疗效可靠。     

跟骨截骨下移延长术治疗陈旧性跟骨骨折

作者应用跟骨截骨下移延长术治疗陈旧性跟骨骨折38例39足,其中34例35足经1～7年随访,91.4%的病人矫形效果和功能恢复优良.手术有效地消除了思足疼痛和跟骨变宽、变短.平足及跟外(内)翻畸形.本文讨论了陈旧性跟骨骨折的临床分类,介绍了手术方法和注意事项.认为本手术能恢复患足的生物力学结构,术后康复时间短,优于距下或三关节融合术.     

楔形截骨术治疗陈旧性跟骨骨折

我院采用楔形截骨术治疗陈旧性跟骨骨折６０例,效果满意,报告如下。临床资料本组６０例中男５２例,女８例;年龄１８～５２岁。后关节面塌陷型骨折２１例,粉碎型骨折３９例。手术时间一般在伤后１．５月～１５个月。患者多为一期保守治疗失败者,手法复位、石膏固定３...     

Chiari骨盆内移截骨术治疗髋臼发育不良

髋臼发育不良指髋臼对股骨头的覆盖不全,关节有半脱位或脱位的趋势。Chiari骨盆内移截骨术由Chiari于1955年提出,该手术是将截骨远端内移,以增加股骨头外侧的包容,使身体的负重力线移向内侧,增强了髋外展肌群的力量,     

Surgical Management of Stage 2 Adult and Pediatric Acquired Flatfoot Without Tendon Transfer or Arthrodesis: A Retrospective Study

Posterior tibial tendon dysfunction (PTTD) is a common pathology of the foot and ankle. Numerous techniques are available to reconstruct the flatfoot. Fusions and tendon transfers are popular methods; however, a wide range of complications have been associated with these procedures. The objective of the present study was to demonstrate the outcomes of reconstructive surgery for flatfoot correction without tendon transfer or arthrodesis. We performed a retrospective study of 43 patients and 56 feet who had undergone flatfoot reconstructive surgery from November 2011 to June 2016, with a mean follow-up period of 60 weeks (range 12 to 60 months). Each patient demonstrated a stage 2 flatfoot deformity classified using the Johnson and Strom classification. Depending on the patient's deformity, the procedures consisted of different variations of gastrocnemius recession, medial displacement calcaneal osteotomy, Evans osteotomy, and Cotton osteotomy. Six different preoperative and postoperative angles were radiographically measured on each foot studied. In all cases, the differences in the preoperative versus postoperative measurements were statistically significant (p?<?.003). We believe the foot and ankle surgeon can correct flatfoot deformity with the use of extraarticular procedures and create a plantigrade functional foot without fusion or tendon transfer.     

The Calcaneal Osteotomy of Dwyer: An Indication for Kiel Bone

Kiel bone has been used with uniformly good results as a bone graft in 15 cases of Dwyer's calcaneal osteotomy. It is suggested that Kiel bone is indicated for this operation in preference to autogenous bone.     

Medial Displacement Calcaneal Osteotomy with Posterior Tibial Tendon Reconstruction for the Flexible Flatfoot with Symptomatic Accessory Navicular

We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p < .01). The improvements in all radiographic parameters were statistically significant between the preoperative and last follow-up examinations (p < .01). The heel valgus of all patients was corrected. Our results have shown that medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular bone is an effective treatment of flexible flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity.     

距下关节塌陷性跟骨骨折的手术治疗

目的探讨距下关节塌陷性跟骨骨折的手术治疗效果。方法自2006年5月至2010年10月我院收治72例77足距下关节塌陷性跟骨骨折患者,按照Sanders分型,Ⅱ型44例49足,Ⅲ型24例24足,Ⅳ型4例4足。骨折均行切开复位植骨内固定,内固定材料选用Y形跟骨钛板,植骨材料均为自体骨。结果术后随访4～48个月,骨折全部愈合,愈合时问为8-20周;74足切口获I期愈合,切口皮肤部分坏死2例2足,换药后自行愈合。1足切口感染,形成溃疡,皮肤软组织缺损,钢板外露,于术后5个月取除内固定,腓肠神经营养血管逆行皮瓣移植,治愈。按美国足踝创伤协会的足部评分标准评定,优52足,良12足,中10足,差3足,优良率为83．12％。结论距下关节塌陷性跟骨骨折应采取手术治疗,植骨使关节面解剖复位,可减少并发症,提高生活质量。     

手术治疗跟骨关节内骨折

目的评价切开复位内固定治疗跟骨关节内(距下关节)骨折的早期临床疗效。方法本组20例,26足跟骨骨折。男14例,女6例;年龄17~56岁(平均29.6岁)。双侧骨折6例。所有患者术前行跟骨正、侧位及轴位X线摄片;9例行跟骨CT扫描三维重建。骨折按Paley分型,型(剪力骨折)2足,型(舌型骨折)11足,型(中央塌陷型骨折)6足,型(粉碎型骨折)4足,型(严重粉碎型骨折)3足。所有患者均采用切开复位、Y形跟骨钢板内固定。术后拍X线片,按Maryland足部评分系统评价术后功能。术后平均随访11.4个月(3~24个月)。结果术后早期X线片显示26足跟骨骨折都获得了良好复位,根据Maryland足部评分,优12足,良11足,可2足,差1足。结论采用切开复位内固定治疗跟骨关节内骨折,可以取得良好的手术效果。     

Medial Meniscus Posterior Root Tear Does Not Affect the Outcome of Medial Open-Wedge High Tibial Osteotomy

BackgroundThis study aimed to verify whether the presence of medial meniscus posterior root tear (MMPRT) affects the clinical and radiographic outcomes of medial open-wedge high tibial osteotomy (MOWHTO) compared to the patients without MMPRT for over a midterm follow-up.MethodsOne hundred fifty-six knees were retrospectively enrolled that underwent MOWHTO and second-look arthroscopy concomitantly with a minimum 5 years of follow-up. Seventy-four knees with MMPRT (MMPRT group) were identified. Eighty-two knees with intact MMPR were assigned to another group (MMPRI group). All knees with torn medial meniscus with or without MMPRT had an arthroscopic partial meniscectomy during the MOWHTO. Clinical evaluation included range of motion, American Knee Society scores, and Western Ontario and McMaster Universities Osteoarthritis Index scores. Radiologically, the Kellgren-Lawrence grade was assessed preoperatively and at the latest follow-up. Cartilage status was also compared through the 2-stage arthroscopy according to the International Cartilage Repair Society grading.ResultsAverage age at operation was 55.8 years (range 42-67), and the average follow-up period was 82.2 months (range 60-148). There were no significant differences in clinical outcomes between the groups. Postoperative changes in Kellgren-Lawrence grade and arthroscopic cartilage status showed no significant differences between the groups. Resected MMPR was remodeled in 41.9% (31/74) of the MMPRT group through the second-look arthroscopy.ConclusionMMPRT does not affect the clinical and radiologic outcomes of MOWHTO compared to those patients without MMPRT over a mid-term follow-up.     

Oblique Displacement Osteotomy According to Crawford Adams for Hallux Valgus

Correction of hallux valgus by oblique displacement osteotomy ad modum Crawford Adams was carried out in 54 cases, of which all but 3 were examined clinically and radiologically 1 year or more after the operation. The median age was 32 years. Seventy-eight per cent were satisfied with the operation, and 64 per cent were totally free of pain. A feeling of stiffness in the first metatarso-phalangeal joint and/or intermittent pain during walking was found in 22 per cent of the patients, all of whom were dissatisfied with the operation. Adams' osteotomy was found to give a satisfactory correction of the deformity of hallux valgus, but the length of the first metatarsal bone could not be maintained.     

Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis

Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of “knee preservation,” has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti‐varus deformity and anti‐valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices.