副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症

 目的 探讨副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症的临床疗效。方法 2009年3月至2011年10月,采用副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症13例(16足),男4例,女9例;年龄18～64 岁,平均41.3岁。单足10例,双足3例;均有明显的跟骨外翻。术后以美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评估后足功能,于X线片上测量足弓高度、跟骨倾斜角(CI)、距跟角(TC)、距骨-第一跖骨角(TMT)。结果 13例均获得随访,随访时间12~31个月,平均16.8个月。术后6个月时11例(13足)无任何疼痛,2例(3足)有长距离行走后足部疼痛。术后随访时AOFAS评分从术前(52.4±6.4)分提高至(88.1±2.8)分;负重侧位X线片上足弓高度从(3.8±0.3) mm提高至(12.0±1.1) mm,CI从9.5°±1.1°提高至20.1°±1.5°,TC从47.3°±2.5°改善至32.3°±2.5°,TMT从17.6°±1.6°改善至6.8°±1.0°;负重正位X线片上TC从39.5°±2.3°改善至26.2°±2.0°,TMT从15.2°±1.7°改善至6.3°±1.0°;轴位X线片上跟骨外翻角从11.3°±1.4°改善至4.2°±2.0°。结论 对与副舟骨相关的平足症的治疗,当存在后足外翻畸形时,副舟骨切除胫后肌腱止点重建跟骨内移截骨术可以明显缓解疼痛,有效矫正畸形,近期疗效良好。     

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.     

跟骨内移截骨术中跟骨内侧的截骨安全区

目的探讨跟骨内移截骨术中跟骨内侧的截骨安全区。方法 10具防腐成人尸体的20只足部标本上,取跟骨结节内缘最低点为A点,内踝尖最低点为B点,足舟骨结节为C点。显露跟骨内侧各神经血管结构后,用游标卡尺测量AB、AC长度,以及各神经血管结构与AB、AC线段交点与A点间的长度。经统计学检验,各组长度符合正态分布,所以可以用后者的长度均值除以AB、AC长度的均值,计算出各神经血管结构在AB、AC上的分布比例。结果跟骨内侧神经、足底外侧神经、足底内侧神经、胫后动脉在AB线上分别位于A点后的：29%、57%、66%、60%;而在AC线上跟骨内侧神经、足底外侧动脉、足底外侧神经、足底内侧动脉、足底内侧神经分别位于A点后的：20%、45%、50%、60%、66%。结论 AB线上A点后29%-57%,AC线上A点后20%45%的区域无重要神经血管走行,满足跟骨内移截骨术在跟骨中后部截骨的要求,可作为跟骨内移截骨术的手术安全区。 更多还原     

跟骨矫形截骨术在跟骨骨折畸形愈合治疗中的应用进展

畸形愈合是跟骨骨折未治疗或不恰当的治疗所带来的一种常见并发症。改善患足疼痛、矫正畸形以及恢复患足功能是临床治疗跟骨骨折畸形愈合的目标,同时也是一大难点。基于近年来国内外学者对于跟骨畸形愈合所致症状的力学机制研究,各种截骨术作为可以特异性矫正跟骨畸形、恢复正常跟骨形态的一类术式,在跟骨畸形愈合的临床治疗中已经得到广泛应用...     

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...     

足外侧柱延长术在平足症治疗中的应用

平足症一直是骨科治疗的难点,国外报道足外侧柱延长术可取得较好疗效。本文综述该手术的方法、手术要点、优缺点、适应证及临床疗效等。     

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...     

Posterior calcaneal displacement osteotomy for the adult acquired flatfoot

The posterior calcaneal displacement osteotomy with flexor digitorum longus tendon transfer is an accepted approach to the stage II posterior tibial tendon dysfunction flatfoot. This reconstructive osteotomy provides a viable alternative to isolated hindfoot arthrodesis procedures. Proper patient selection and sound surgical technique ensure favorable postoperative results. Complications, though limited, may include sural neuritis, peroneal tendonitis, undercorrection, and peritalar arthrosis.     

Calcaneus displacement osteotomy in pediatric flatfoot

Severe unstable pes valgus that can no longer be treated conservatively can be corrected and stabilized by corrective osteotomy of the calcaneus. An important advantage of calcaneus osteotomy is the conservation of the subtalar joint. Calcaneus displacement osteotomy requires less effort from the surgeon, and the correction is more effective than wedge osteotomy of the calcaneus.     

Medial arch strain after medial displacement calcaneal osteotomy: an in vitro study

Posterior tibial tendon dysfunction with concomitant progressive flatfoot deformity is associated with ligamentous failure along the medial arch. Medial displacement calcaneal osteotomy is being used alone and in combination with other procedures, with the expectation that it contributes to maintaining the arch. The objective of this study was to examine the effect of osteotomy on reducing medial arch strain. Whole cadaver feet were subjected to vertical loads while plantigrade. Spring ligament length was monitored using liquid metal displacement gauges. Two outcomes were examined: the length of the ligament under one-half body weight and the change in length of the ligament per unit of applied load. The medial displacement calcaneal osteotomy allowed elongation of the ligament with weightbearing, but at a shorter ligament length. This afforded the spring ligament protection from the levels of force experienced in the intact and lateral column-lengthened conditions.     

Medial displacement calcaneal tuberosity osteotomy in the treatment of posterior tibial insufficiency.

The loss of function of the posterior tibial tendon has been associated with a progressive deformity in adults, resulting in a painful flatfoot. Patients who have a painful flatfoot usually develop a valgus deformity of the hindfoot and an abduction deformity of the forefoot. If these deformities are supple, a medial displacement calcaneal tuberosity osteotomy together with a soft tissue repair by talonavicular capsulorraphy and repair of the spring ligament associated with a flexor digitorum tendon transfer to the posterior tibial can result in a satisfactory outcome.     

The Evans calcaneal osteotomy for correction of flexible flatfoot syndrome

The Evans calcaneal osteotomy is used to correct the flexible flatfoot deformity. The procedure restores functional integrity to the medial longitudinal arch and reestablishes the locking mechanism of the midtarsal joint complex. A preliminary analysis of 36 cases (50 feet) performed at Atlanta Hospital and Medical Center during the past 3 years has yielded favorable results.     

Medial displacement metatarsal osteotomy for treatment of painful bunionette

A medial displacement metatarsal osteotomy was performed in 23 feet of 16 patients who had painful bunionette deformities. The mean follow-up period was 22 months. Relief of symptoms, e.g., lateral forefoot pain, plantar pain, toe deformity, functional limitation, and shoewear limitation, was achieved. Lateral forefoot tenderness also was relieved. Forefoot width and intermetatarsal four-to-five, intermetatarsal two-to-five, and metatarsophalangeal five angles were consistently decreased. Overall results based on objective and subjective criteria were good in 88%, fair in 4%, and failure in 8%. Complications were superficial wound infection in one case and possible nonunion in one case. This operation is appropriate for the painful bunionette with metatarsal splaying or outflaring with or without intractable plantar keratosis and varus toe deformity.