影像学检查在Muller-Weiss病诊断中的应用价值

目的:探讨Muller-Weiss病的影像学表现,评价影像学检查在其诊断中的应用价值。方法:2015 年9 月至2020 年8 月收集治疗的26 例 Muller-Weiss病患者的影像学资料,其中男7例,女19例;年龄43~68(52.7±4.6) 岁。X 线检查主要观察足舟骨的形态、位置,并在负重正位X线片上测量距骨中轴线-第1跖骨中轴线的夹角(talar-first metatarsal angle,TFM),在负重侧位片上测量足弓角、距骨中轴线-第1跖骨中轴线的夹角(Meary角);CT检查主要评价足舟骨的形态、密度、邻近骨关节间隙、位置;MRI检查主要观察足舟骨的形态、信号、软骨及周围软组织改变。结果:26 例患者单侧受累21例,双侧受累5例;X线检查主要表现为足舟骨外侧部压缩变扁,呈"逗号状"或"水滴状",舟骨向内侧移位,部分骨质碎裂,周围骨关节增生,密度高低不均,关节间隙变窄;根据患足在负重侧位X线片上的 Meary角和畸形程度进行Maceira分期,其中Ⅰ期0例,Ⅱ期2例,Ⅲ期11 例,Ⅳ期9 例,Ⅴ期4 例。CT检查,显示骨质碎裂、舟骨向内侧移位、"距楔关节"的形成等。MRI检查主要表现为足舟骨形态不规则、信号不均,关节间隙变窄,距舟关节面增生、软骨破坏,跗骨关节积液,周围软组织肿胀。结论:Muller-Weiss病具有较特异的影像学表现,结合患者年龄、性别、临床病史可作出准确诊断;术前影像学检查可对疾病进行分期,帮助临床医生制定更好的手术方案,术后影像学检查能较好评价手术效果。     

Müller-Weiss病的研究现状

Müller-Weiss病也称为Müller-Weiss综合征,为临床上少见的成人足舟骨坏死,多发生于中老年女性,以中足慢性疼痛、足舟骨压缩碎裂和后足进行性畸形为特点[1].1927年德国外科医生Walther Müller报告了1例双侧足舟骨畸形的患者,随后的发现使他提出此病是一种先天性缺陷;1929年奥地利放射科医生Konrad Weiss发现2例患者有类似的表现,但他认为此病是一种骨坏死.由于本病的病因一直存在争议,因此,目前多用他们两人的名字对此病命名.值得一提的是,Schmidt在1925年报告了l例足舟骨有相似改变的患者[2-3].曾经有学者使用"两部分足舟骨"描述此病[4].     

药物局部注射治疗儿童足副舟骨痛12例报告

足副舟骨并不少见 ,据报道 10 %～ 14 %的正常足存在副舟骨。除同时合并扁平足外 ,因副舟骨的存在而造成儿童足局部疼痛临床较少见。自 1996年以来 ,作者收治儿童足副舟骨痛 12例 ,采用药物局部注射治疗 ,效果满意 ,现报告如下 :1　临床资料1.1　一般资料　本组 12例 ,男 3例 ,女 9例 ;年龄 8～ 14岁 ;病程 3～ 18个月。除 1例主诉因长跑后感足内侧疼痛外 ,其余均以无明显原因的足内侧疼痛就诊。足内侧局部压痛 ,可扪及异常突出物 ;双足Ｘ线片证实副舟骨的存在 ,有时可见患侧副舟骨异常骨化增生 ,表面粗糙 ,应与舟骨结节撕脱骨折相鉴别。1.2…     

距舟楔关节融合治疗Muller-Weiss病的疗效分析

背景：Muller-Weiss病是一种临床少见且原因不明的足部疾病。对于保守治疗无效的患者,可行手术治疗,治疗的目的是减轻患者症状,纠正患足畸形。目的：评估距舟楔关节融合治疗Muller-Weiss病的效果。方法：2008年5月至2012年4月,采用距舟楔关节融合自体髂骨植骨治疗Muller-Weiss病患者28例,男2例,女26例;年龄44~65岁,平均55.3岁。根据Maceira分期：Ⅲ期8例,Ⅳ期9例,Ⅴ期11例。早期使用空心拉力螺钉加骑缝钉行距舟楔关节融合10例;后期采用空心拉力螺钉加“X”形锁定接骨板融合18例。比较患者末次随访与术前的美国足踝医师协会（AOFAS）中足评分与视觉模拟评分（VAS）结果。结果：术后26位患者获得随访,随访时间9~24个月,平均16.2个月。术后未发生切口感染,皮肤坏死及内固定断裂等并发症,患者症状及行走功能得到明显改善,所有患足都获得牢固融合,融合时间12~16周,平均13.4周。术前AOFAS中足评分为（42.6±13.4）分,末次随访时为（88.0±12.0）分（P＜0.05）。术前VAS为（6.2±2.4）分,末次随访时为（0.6±0.4）分（P＜0.05）。结论：对于中末期Muller-Weiss病的治疗,距舟楔关节融合是一种可靠有效的治疗方法。     

采用足舟骨外移截骨并周围关节融合治疗Müller-Weiss病的疗效分析

目的探讨足舟骨外移截骨并距-舟-楔关节融合治疗Müller-Weiss病的疗效。方法回顾性分析2014年2月至2018年3月深圳平乐骨伤科医院创伤骨科收治的13例Müller-Weiss病的病例。所有患者均行足舟骨外移截骨并周围关节融合术。术中显露距舟及舟楔关节囊,松解足舟骨周围组织,完整取出舟骨。咬除舟骨外侧骨性组织留作植骨材料,以钢板及螺钉行距-舟-楔关节融合,观察其疗效。结果13例均获随访,随访时间14~36(18.2±3.3)个月。术后均获得成功融合,未发现感染、皮肤坏死、血管神经损伤等并发症。与术前比,术后12个月的疼痛视觉模拟评分(VAS)明显降低(P<0.05),踝-后足评分系统(AOFAS)评分升高(P<0.05)。结论足舟骨外移截骨并距-舟-楔关节融合治疗Müller-Weiss病的疗效可靠,并减少植骨步骤,是一种较好的治疗方法。     

外固定架治疗足舟骨缺血性坏死

足舟骨缺血性坏死又称Kohler病,主要表现为无明显诱因的足背部疼痛,放射学可以发现足舟骨变扁、硬化和不规则骨质稀疏,常发生于6岁以下儿童,多见于男孩,发病时足舟骨及周围疼痛,行走加重,严重影响青少年儿童的活动和生长发育,治疗多以保守治疗为主,病程较长。近年研究表明,足舟骨坏死与其生长旺盛阶段受压相关。自2004年6月至2008年12月,我们应用自行设计的双边外固定架通过撑开减压的方法对舟骨坏死进行了试验性治疗,取得了良好的疗效,现报告如下。     

单纯副舟骨切除术治疗足副舟骨疼痛综合征

目的：观察及评价单纯副舟骨切除术治疗足副舟骨疼痛综合征的临床疗效。方法：从2006年11月至2008年12月,收治足副舟骨疼痛综合征患者23例25足,全部采用单纯副舟骨切除术治疗,其中男14例,女9例;年龄8～35岁,平均14.6岁;病程6个月～12年。主要症状是跑步或行走后足疼痛,多为间歇性,查体足舟骨粗隆处异常突起伴压痛,X线或CT检查发现副舟骨存在。治疗是以足副舟骨为中心做一长约2cm弧形切口,剖开或部分切断胫后肌腱,暴露出副舟骨并切除,明显突起的舟骨隆突部分咬除和修整,胫后肌腱均予修复。术后佩戴内翻位支具2周扶双拐不负重行走,2周后逐渐弃拐负重,3个月内避免剧烈跑跳运动。有残留症状者结合理疗和足弓垫支撑垫等处理措施。术后随访评估患者症状缓解程度及活动恢复情况。结果：所有病例术后随访3～18个月,平均12个月。症状完全消失21足,大部分缓解4足（其中3足合并轻度扁平足,1足合并陈旧扭伤）。平均住院5d,无切口感染,均恢复日常生活和工作。结论：单纯副舟骨切除术治疗足副舟骨疼痛综合征,对胫后肌腱损伤小,不干扰足底内侧纵弓,术后无须长时间制动,住院时间短,创伤小,临床疗效较好,特别适合无扁平足及陈旧足外伤患者。     

融合法治疗成人Ⅱ型症状性足副舟骨21例

目的回顾性分析采用舟骨结节截骨足副舟骨内固定融合的方法治疗成人Ⅱ型症状性足副舟骨的疗效。方法采用舟骨结节截骨足副舟骨内固定融合的方法治疗此类疾患21例。结果本组21例(23足)均行手术治疗,术后随访2年～7年4个月,治疗效果满意。结论舟骨结节截骨足副舟骨内固定融合是治疗成人Ⅱ型非平足症性症状性足副舟骨的良好方法。     

足舟骨骨折的临床研究进展

足舟骨骨折不多见，约占中足骨折的6％，而足舟骨体部骨折约占舟骨骨折的25％。足舟骨是足内侧柱的一部分，位于足内侧柱的中央，作为足内侧柱的关键点在步态中起着重要的作用。足舟骨骨折处理不当，会出现足内侧柱破坏、足弓塌陷，极易引起行走时无力、疼痛等临床症状。本文主要就足舟骨骨折的诊断和治疗方面的研究进展作一综述。     

足副舟骨2型手术治疗1例

足内侧的疼痛临床上比较常见,多发生于青少年,常表现为与运动、活动相关的疼痛,足副舟骨的存在是该病症的常见原因之一,其中,以2型足副舟骨最多见. 病例:男性,22岁,学生,3个月前打篮球时扭伤左足,伤后左足内侧疼痛肿胀明显,局部瘀血,当时未特殊处理.休息1周后局部肿胀、淤血好转,但疼痛持续.现患者正常行走不痛,左足内翻痛,不能跑跳,遂来就诊.查体见左足副舟骨区压痛明显,足内旋抗阻痛阳性,左踝关节未见明显异常,肢体末梢感觉及血运正常.X线片示左足副舟骨.     

Maladie de Muller-Weiss idiopathique : à propos d’un cas traité chirurgicalement

The authors report a case of idiopathic Muller-Weiss disease in a 34-year-old male. Treatment was surgical and consisted in a fusion of talonavicular and naviculocuneiform joints, with excellent clinical results. X-rays showed that osteonecrosis of navicular bone was stopped.     

Osteochondritis of the navicular: a case report

Brailsford's disease and Kohler's disease are two conditions of uncertain etiology affecting the navicular in adults and children, respectively. Kohler's disease has been universally agreed to have an excellent outcome in all cases. There have been no recorded cases of a child with Kohler's disease having persistent clinical and radiological abnormalities into adulthood and no cases of patients with Brailsford's disease having had abnormalities in childhood. This case report presents a teenage patient with osteochondritis of the navicular bone with symptoms that persisted into skeletal maturity.     

Osteoid osteoma of the tarsal navicular bone: an uncommon localization

We report a case of subchondral osteoid osteoma of the tarsal navicular bone. Osteoid osteomas are often located in the foot, mainly in the talus. This is the first report in the literature of a tarsal navicular bone localization. Diagnosis was difficult and established late due to misleading clinical presentation simulating mediotarsal arthritis.     

Bilateral Köhler's disease in identical twins

K?hler's disease is an uncommon idiopathic osteochondrosis of the tarsal navicular bone. The diagnosis is clinical and the natural history is benign. The treatment is symptomatic, including shoe supports when the symptoms are mild and initial cast immobilization for at least 8 weeks when the symptoms are more intense. The final clinical outcome is always favorable. This article reviews the development of bilateral K?hler's disease in identical twin brothers with simultaneous onset and parallel clinical course. Bilateral involvement in identical twins, to the authors' knowledge, has not been reported in the literature. Although this is a preliminary finding, it can imply that an unknown genetic predilection may exist and relate to the appearance of this rare disease.     

Fractures of the body of the tarsal navicular bone: case reports and literature review

Four patients sustaining tarsal navicular body fractures are presented. Analysis based on these cases and on 36 patients suffering from identical fractures reported in the literature led to a new mechanical assumption: the axial compression on the foot, as a result of falling from height, causes impaction of the talus into the body of the navicular bone. The clinical followup results reported are usually disappointing. Favorable results are obtained in a vertical two-part fracture, by an open reduction and internal fixation of the tarsal navicular body fracture. In highly comminuted fractures, talo-navicular-cuneiform arthrodesis can be carried out.     

The anatomy of the navicular and periarticular structures

The navicular bone, located in the midfoot, articulates with the head of the talus, cuboid, and the three cuneiform bones that are involved in the acetabulum pedis. It gives attachment to the spring ligament (superomedial and inferior calcaneonavicular ligament)that can be injured in a failure of the posterior tibialis tendon and cause an adult acquired flatfoot deformity. The navicular bone provides insertion for the posterior tibialis tendon. Some pathologies can be related to the presence of an accessory navicular bone.Osteonecrosis or stress fractures can affect the navicular bone because of its poor vascularization, especially in its central portion.     

Adult Flat Foot With Multiple Accessory Navicular Bones Treated Surgically: A Case Report and Review of the Literature

Multiple accessory navicular bones is an extremely rare condition. To the best of our knowledge, only 8 cases in 2 imaging studies have been published. We report a case of a patient with flat foot with 2 accessory navicular bones. This patient needed to be treated surgically, and the surgery was successful, with short-term follow-up. We believe this is the first case of multiple accessory navicular bones to be treated surgically in English literature. The incidence of multiple accessory navicular bones might be higher. There is a risk to remaining ossicles without resection or fixation during surgery; therefore, we strongly recommend using not only radiographs, but also 3-dimensional computed tomography scans or magnetic resonance imaging scans to confirm the type of accessory navicular bone, at least before surgery, for both painful accessory navicular bone and flat foot with accessory navicular bone.     

Arthrodesis of the navicular

Isolated arthrodesis of the navicular complex is a means of restoring the integrity of the medial column. This facilitates pain relief and improved function. This option should be considered in the treatment of degenerative disease in these joints. Grade III PTTI may be managed with arthrodesis of the navicular complex , provided degenerative changes are limited to the talonavicular-naviculocuneiform joints. This procedure must include concomitant correction of the hindfoot. Osseous necrosis or bone loss that is due to severe degeneration may be managed successfully with cancellous or structural grafting that is sufficient to maintain the length of the medial column. If extensive grafting increases the risk of nonunion, the navicular or its remnants can be excised and a talocuneiform fusion may be performed. Successful management of conditions that affect the navicular complex requires meticulous attention to restoration of medical column. Optical results also demand consideration of overall alignment and condition of adjacent joints.