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.     

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。     

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。     

重建钢板内固定治疗关节内跟骨骨折20例体会

跟骨骨折是一种临床常见的严重复杂创伤.按Essex-Lopreti分类法,可分为波及与不波及跟距关节两大类.临床以前者多见,约占整个跟骨骨折的70%～80%[1].由于关节内跟骨骨折用非手术治疗恢复其解剖形态及功能结构极其困难,常遗留疼痛、扁平足、足跟增宽等后遗症.本院自1999年2月至2002年3月以来,对该类骨折采用切开复位重建钢板内固定的治疗方法,取得了较为满意的效果.     

Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction,a prospective randomized controlled study

PurposeAdult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications.Patient and methods42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43–55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported.ResultsAt 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊ ± 2.8 versus 13.95̊ ± 2.2 (p = 0.001) and 13.70̊ ± 2.2 versus 19.05̊ ± 3.2 (p < 0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion.ConclusionLCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.     

Three-dimensional displacement after a medializing calcaneal osteotomy in relation to the osteotomy angle and hindfoot alignment

BackgroundA medializing calcaneal osteotomy is frequently performed to correct adult-acquired flatfoot deformities, but there is lack of data on the associated three-dimensional variables defining the final correction. The aim of this study was to assess the correlation between the pre-operative hindfoot valgus deformity and calcaneal osteotomy angles and the post-operative calcaneal displacement.MethodsWeight-bearing CT scans obtained pre- and post-operatively were retrospectively analyzed for sixteen patients. Corresponding three-dimensional bone models were used to measure valgus deformity pre- and post-operatively, inclination of the osteotomy and displacement of the calcaneus. Linear regression was conducted to assess the relationship between these measurements.ResultsOn average, the hindfoot valgus changed from 13.1° (±4.6) pre-operatively to 5.7° (±4.3) post-operatively. A mean inferior displacement of 3.2 mm (±1.3) was observed along the osteotomy with a mean inclination of 54.6° (±5.6), 80.5° (±10.7), −13.7° (±15.7) in the axial, sagittal and coronal planes, respectively. A statistically significant positive relationship (p < .05, R² = 0.6) was found between the pre-operative valgus, the axial osteotomy inclination, and the inferior displacement.ConclusionsThis study shows that the degree of pre-operative hindfoot valgus and the axial osteotomy angle are predictive factors for the amount of post-operative inferior displacement of the calcaneus. These findings demonstrate the added value of a computer-based pre-operative planning in clinical practice.Level of evidence II Prospective comparative study.     

Flexor-Digitorum-Longus-Transfer und medialisierende Kalkaneusosteotomie zur Therapie der zweitgradigen erworbenen Plattfußdeformität

Acquired flatfoot deformity is characterized by flatening of the longitudinal arch of the foot and a varus alignement of the hindfoot due to insufficiency of the postero-medial soft tissue structures and is divided in four different stages. Stage II represents a flexible flatfoot deformity without active hindfoot inversion due to insufficiency of the Tendon of the posterior tibial muscle. Symptoms include pain at the medial hindfoot and difficulites associated with walking on uneven surfaces. Clinically, there occurs hindfoot varus and excessive forefoot abduction (‚too many toes sign’). Imaging studies include weight bearing a/p and lateral xrays as well as MRI scans in order to visualize tendon degeneration. Conservative treatment options include longitudinal arch support and physical therapy respectively. In case of failure of conservative treatment surgical options include flexor digitorum longus transfer and medial displacement calcaneal osteotomy. This procedure reveals good functional results with the restoration of single heel rise.     

Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer

Seventeen consecutive pediatric patients (34 feet) underwent reconstruction of flexible pes planovalgus deformity between 1994 and 1999. The average follow-up was 24.9 months (range, 8 to 48 months). All patients underwent a medial split tibialis anterior tendon transfer/tenodesis in combination with an Evans calcaneal-lengthening osteotomy, Kidner or modified Kidner procedure, and tendo-Achilles lengthening. Various angular parameters were measured both preoperatively and postoperatively, and improvement in each was noted. The calcaneal pitch improved by an average of 26 degrees (85.88%), the lateral talometatarsal angle improved by an average of 26.4 degrees (96.15%), the lateral talocalcaneal angle improved by an average of 14.8 degrees (34.26%), the anteroposterior talometatarsal angle improved by an average of 21.9 degrees (81.92%), the anteroposterior talocalcaneal angle improved by an average of 15.9 degrees (37.95%), the cuboid abduction angle improved by an average of 13.8 degrees (87.34%), and the talonavicular coverage angle improved by an average of 26.7 degrees (94.68%). Postoperative improvement of all angular measurements was statistically significant at the 95% confidence level (P =.05). In addition, American Orthopedic Foot and Ankle Society hindfoot/ankle scoring was performed preoperatively, 3 months after the second foot surgery, and at the time of maximal follow-up. A preoperative average score of 68.59 improved to 85.76 at 3 months after the second foot surgery, and improved to 96.55 at the time of the last follow-up. All 17 patients were satisfied with their surgical result because all returned for correction of the contralateral foot. All patients indicated a uniform willingness to have these procedures performed again.     

Double calcaneal osteotomy in treatment of flexible planovalgus foot deformity in ambulatory cerebral palsy. A case series study

BackgroundThe aim of this prospective non randomized case series study was to assess the intermediate-term outcomes of double calcaneal osteotomy (lateral column lengthening and medial slide calcaneal osteotomy) use in ambulatory cerebral palsy with flexible planovalgus feet.Methods16 cases with planovalgus feet were surgically treated by double calcaneal osteotomy and observed over an average of 33.5 months. The mean age at the time of surgery was 10.74 years. The functional outcomes were assessed clinically and radiologically.ResultsThere were a statistical improvement of clinical heel valgus and all radiological parameters as regard talar head uncoverage, calcaneal pitch, talo-calcaneal angle, and talus 1st metatarsal angle at the end of follow up period.ConclusionDouble calcaneal osteotomy is a good option in the treatment of flexible planovalgus feet in ambulatory cerebral palsy patients.     

Evans跟骨外侧延长术治疗距跟联合合并后足外翻畸形

目的探讨Evans跟骨外侧延长术治疗距跟联合合并后足外翻畸形的疗效。方法2014年1月—2017年10月,采取Evans跟骨外侧延长术治疗10例(13足)距跟联合合并后足外翻畸形患者。男6例(8足),女4例(5足);年龄13~18岁,平均15.8岁。病程10~14个月,平均11.5个月。患侧跟骨外翻、前足外展、足弓低平。疼痛部位:跗骨窦4足、距跟联合5足、踝关节4足。Silverskiold试验腓肠肌腱膜紧张3例(4足),跟腱挛缩7例(9足)。术前美国矫形外科足踝协会(AOFAS)踝与后足评分为(46.54±9.08)分,行走1 km后疼痛视觉模拟评分(VAS)为(6.54±0.88)分。术后采用AOFAS踝与后足评分、VAS评分,以及X线片测量距骨-第1跖列角(talar-first metatarsal angle,T1MT)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨倾斜角(talar-horizontal angle,TH)、跟骨倾斜角(calcaneal pitch angle,CP)、跟骨外翻角(heel valgus angle,HV),评价手术疗效。结果术后切口均Ⅰ期愈合。10例患者均获随访,随访时间12~30个月,平均18个月。末次随访时,AOFAS踝与后足评分为(90.70±6.75)分,VAS评分为(1.85±0.90)分,均较术前明显改善(t=-23.380,P=0.000;t=35.218,P=0.000)。X线片复查示截骨均达骨性愈合,愈合时间为2~4个月,平均3个月。末次随访时,T1MT、TCA、TH、HV均较术前明显降低,CP明显提高,差异有统计学意义(P<0.05)。随访期间1例(1足)疼痛缓解不明显,1例(1足)出现腓肠神经皮支损伤症状。结论对于距跟联合合并后足外翻畸形患者,Evans跟骨外侧延长术可以有效纠正畸形、缓解疼痛。     

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.     

Effects of variations in Dwyer calcaneal osteotomy determined by three-dimensional printed patient-specific modeling

Dwyer (lateral calcaneal closing wedge) osteotomy is commonly used in surgical correction of heel varus deformity. The purpose of this study was to determine the effect of wedge size and angle of osteotomy on deformity correction using preoperative imaging analysis with three-dimensional (3D) printed modeling. Seven patients diagnosed with pes cavovarus deformity who underwent Dwyer calcaneal osteotomy were identified retrospectively. Preoperative computed tomogrphy scans were used to create 3D printed models of the foot. After18 variations of osteotomy and fixation performed for each foot, Harris heel and Saltzman images were obtained. The angle between the tibia-talus axis and calcaneal-tuber axis was measured and compared to pre-osteotomy state. Change in the calcaneal lengths was also analyzed. The average degree correction of deformity per mm of bone resected was 3.8 ± 0.2 degrees in the Harris Heel view and 2.7 ± 0.8 degrees in the Saltzman view. A significant increase in correction was obtained with 10 mm compared with 5 mm wide wedges (P < .001). The difference in correction was not statistically significant between 30 and 45 degree cuts or osteotomy distance from the posterior calcaneal tuberosity, but a 45 degree sagittal angle resulted in less calcaneal shortening compared to 30 degrees (P = .02). A clinically driven method using patient-specific 3D models for determining effects of calcaneal osteotomy variables in correcting hindfoot alignment was developed. In summary, the amount of wedge resected impacts hindfoot alignment more than location and sagittal angle of the cut. Calcaneal shortening depends on sagittal angle of the cut.     

Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet

Purpose

Stage II posterior tibial tendon dysfunction (PTTD) can be treated by flexor digitorum longus (FDL) tendon transfer and medial displacement calcaneal osteotomy (MDCO). Numerous authors have studied the clinical and radiographic results of this procedure. However, little is known about the kinematic changes. Therefore, the purpose of this study was to assess plantar-pressure distribution in these patients.

Methods

Seventy-three patients with PTTD stage II underwent FDL tendon transfer and MDCO. Plantar pressure distribution and American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed 48 months after surgery. Pedobarographic parameters included lateral and medial force index of the gait line, peak pressure (PP), maximum force (MF), contact area (CA), contact time (CT) and force-time integral (FTI).

Results

In the lesser-toe region, PP, MF, CT, FTI and CA were reduced and MF in the forefoot region was increased. These changes were statistically significant. We found statistically significant correlations between AOFAS score and loading parameters of the medial midfoot.

Conclusions

Study results reveal that FDL tendon transfer and MDCO leads to impaired function of the lesser toes during the stance phase. However, there seems to be a compensating increased load in the forefoot region.     

Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot

Introduction Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal soft tissue reconstruction. Materials and methods Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone, the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm in the plantar direction, and rotated laterally decreasing the first–second intermetatarsal angle to 5 degrees. Results The mean AOFAS score was 54.1 ± 2.8 points at pre-operation and 92.8 ± 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first–second intermetatarsal angle (P < 0.0001), first–fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar angle was 2.6 ± 1.4 and 2.4 ± 1.5 degrees, respectively. Conclusion This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first–second intermetatarsal angle.