Charnley关节夹在足三关节固定术中的应用

Ｃｈａｒｎｌｅｙ关节夹在足三关节固定术中的应用陈秋生，邵振海，赵左向，吴德贤马卓尧，亓海国，胡广州，刘宁富我院自１９７８年至１９９０年采用Ｃｈａｒｎｌｅｙ关节夹固定用于三关节截骨融合术３９例，随访３２例，获得满意效果。一般资料３２例，３３足。男性１７...     

环柄式外固定器在马蹄内外翻足截骨融合术中的应用

观察环柄式外固定器在马蹄内外翻足截骨融合术中的应用效果。方法２９例３６足行足附二关节、三关节截骨融合术，并应用环柄式外固定器固定。结果随访２９例，随访时间９－３０个月，３６足全部骨性融合。３３足外观基本正常，恢复三点负重，步态平稳。优良率９１．７％。     

改良三关节融合术矫正马蹄内翻足畸形43例

改良三关节融合术矫正马蹄内翻足畸形４３例翁树秋肖正龙杨小山徐开明徐景卫指导：邬华彬我院从１９８９年１２月～１９９５年１２月采用改良的三关节截骨融合和肌腱转移术矫正马蹄内翻足畸形４３例，临床观察效果满意。报告如下：１临床资料４３例中，男２４例、女１９例...     

三关节融合术治疗马蹄内翻足畸形并发症的原因和处理

三关节融合术治疗马蹄内翻足畸形并发症的原因和处理江苏省徐州市第四医院骨科（２２１００９）魏加强，孙东友我院从１９７０～１９９３年共采用三关节融合术矫正马蹄内翻足５６８例，资料完整４４８例，平均随访６年半在４４８例中６０例有并发症，加他院转入我院的１２...     

截骨融合治疗严重僵硬性马蹄足畸形的临床疗效观察

目的 :探讨截骨融合术矫正严重僵硬性马蹄足畸形的临床疗效。方法 :自2010年4月至2015年10月,采用空心钉行截骨关节融合术矫正13例(16足)严重僵硬性马蹄足畸形患者,其中男6例,女7例;年龄39~62(49.6±5.3)岁;病程5~27(9.0±4.8)年。采用三关节截骨融合术6例(9足),四关节截骨融合术4例(4足),胫距跟关节截骨融合术3例(3足)。所有患者术前表现为患足疼痛、足跟不能接触地面、无法行走。观察患者术后并发症情况,并采用AOFAS评分进行临床疗效评定。结果:13例患者获得随访,时间18~24个月,平均20个月。术后仅有1例出现伤口部分皮肤坏死,予伤口换药、抗感染治疗后痊愈。末次随访时所有患足达到骨性愈合,时间12~16周,平均13.2周。AOFAS评分由术前的11.85±10.66提高至术后的81.38±3.69,差异有统计学意义(t=-25.67,P0.05);其中良15足,可1足。结论 :根据患者情况,可采用胫距跟关节融合、三关节或者四关节融合术矫正部分严重僵硬性马蹄足畸形,并可取得较满意的临床疗效。     

Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足

目的探讨用Ilizarov张力-应力法则结合三关节有限截骨术矫正成年人重度马蹄内翻足畸形的疗效。方法1996年1月～2003年2月,应用Ilizarov张力-应力法则结合三关节有限截骨一期矫正成年人重度马蹄内翻足患者12例13个足,男9例,女3例;年龄20～36岁,平均26岁;左足4例,右足7例,双足1例。病因先天性马蹄内翻足3例,小儿麻痹后遗足畸形6例,外伤1例,脑性瘫痪后遗足畸形1例,小腿海绵状血管瘤施行放射治疗后遗马蹄内翻足畸形1例。根据病情,术前组装Ilizarov踝足关节牵伸器,术中先实施足的后内侧软组织有限松解和三关节切骨术,依照Ilizarov的穿针固定原则,安装具有三维矫形功能的踝足关节牵伸器。术后7d旋转螺纹牵伸杆,逐渐矫正足内翻、内收和前足下垂畸形,在牵伸矫形过程中患足可负重行走。结果12例患者均获得随访,随访时间7个月～4年,平均15个月,畸形未复发,足持重行走功能良好。术后平均牵伸71d。10例11个足达到0°位全足持重,2例保留15°～20°足下垂角(因合并下肢短缩)。术后无一例发生切口和针道感染、皮瓣坏死、血管神经损伤、骨不愈合等并发症。结论Ilizarov张力-应力法则结合三关节有限截骨矫正成年人重度马蹄内翻足是安全、微创、有效的方法。     

三关节融合术治疗儿麻后遗马蹄内翻足远期效果综合分析

目的：综合评价三关节融合术治疗儿麻后遗马蹄内翻足的远期疗效。方法：用临床标准和足底压力测定对术后１６年３个月的２４名病人２４足进行了综合评定。结果：临床效果优良１９足,可５足;Ｘ线片显示：三关节融合率、踝关节退行性变发生率１００％。畸形复发为肢短造成的马蹄足复发。患足疼痛发生在踝关节及足底胼胝区,胼胝区压力明显大于对侧足相应区域（Ｐ〈０．０１）。临床疗效优良者,其动、静态足底压力较均匀。临床疗效可     

下垂足畸形矫治远期疗效分析

目的:观察关节融合治疗下垂足畸形的远期疗效。方法:采用三关节融合、跗间截骨,并有大部分病例同时行肌腱移位,肌腱悬吊、跟腱延长、跖筋膜松解及第一、第五跖骨基底部楔形截骨等联合手术,治疗各种原因引起的下垂足畸形。结果:520例528只足术后随访时间最长24年,最短1年,平均14年3个月,优良率占77%。结论:通过远期疗效观察,对提高手术效果有较大的临床意义。     

足三关节融合术畸形复发的原因与对策

目的：探讨足三关节融合术畸形复发的原因与对策。方法：对1979—2001年的801例(855足)三关节融合术进行了回顾性调查，对其中的19例畸形复发原因进行了分析，并提出应对措施。结果：本组19例畸形复发的病人均行再次手术，矫正足三关节的复发畸形。术后经3—10年的随访，全部病人行走无疼痛，外观基本正常。结论：重视肌力平衡问题，把握手术适应证和掌握截骨的要点是避免足三关节融合术畸形复发的重要环节。     

下垂高弓内翻足手术治疗并发症的探讨：附851例报告

下垂高弓内翻足畸形矫正并获得正常或基本正常的持重行走功能是比较困难的。自１９７０年以来，采取三关节融合，跗间截骨手术，并有部分病例同时行肌力平衡、肌腱悬吊和第１、５跖骨基底部楔形截骨等联合手术，治疗下垂高弓内翻足８５１例８８７只足，经６０３例６２８只足平均１０年５个月时间的随访，效果满意，并且有效地预防一些并发症的发生。     

The results of a primary and staged pantalar arthrodesis and tibiotalocalcaneal arthrodesis in adult patients

Twenty-three patients (twenty-seven feet) with either a primary or staged pantalar arthrodesis or a tibiotalocalcaneal arthrodesis were evaluated to determine their clinical status. The main indication for the operation was the presence of severe pain unresponsive to non-operative treatment. Fourteen feet (twelve patients) had a pantalar arthrodesis; a fusion of the ankle, subtalar, talonavicular and calcaneocuboid joints. Half the feet in this group had either a triple arthrodesis or an ankle fusion performed at an earlier time. The remaining seven feet had all joints fused during the same operation. Thirteen feet (eleven patients) had a tibiotalocalcaneal arthrodesis. Two of these feet had an ankle arthrodesis performed four and six years previously. The other eleven had the ankle and subtalar joints fused during the same operation. All patients were followed for a mean of fifty-five months (14 to 159 months) from the time of their final arthrodesis procedure. Overall, twenty-three of the twenty-seven feet achieved a solid arthrodesis of all joints operated upon. Four feet had a failure of fusion of only a single joint and all were in the pantalar group. The mean time to radiographic fusion was twenty-three weeks and resulted in a plantigrade foot with an average tibia-floor angle of 87 degrees. Complications occurred in ten feet (37%); of which there were three deep infections; two ankles and one subtalar joint. These arthrodeses procedures resulted in marked relief of the patients' preoperative pain, the main indication for performing the surgery. Postoperatively there was no pain in eleven feet, mild occasional pain in thirteen feet, and moderate pain in only three feet. However, when all parameters of our clinical rating scale were evaluated, only five patients had an excellent clinical result, nine were rated good, three were rated fair and six patients had a poor result. These operations must be considered to be salvage procedures. They are technically difficult to perform and major complications may occur. Pain relief appears to be the main indication for performing these operations, and may account for whatever improvement occurs in the patient's function.     

Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients.

BACKGROUND: Triple arthrodesis is used to treat major deformities of the hindfoot and is often performed in young patients. The purpose of this study was to assess the long-term outcomes of triple arthrodesis in young patients. METHODS: Sixty-seven feet of fifty-seven patients were evaluated at an average of twenty-five and forty-four years after triple arthrodesis. The most common indication for the operation was neuromuscular imbalance of the hindfoot, which was secondary to poliomyelitis in thirty-seven feet (55 percent), Charcot-Marie-Tooth disease in six (9 percent), spinal cord abnormalities in four (6 percent), cerebral palsy in three (4 percent), and Guillain-Barré syndrome in one (1 percent). RESULTS: Fifty-two feet (78 percent) had some residual deformity after the arthrodesis. However, these deformities appeared to be nonprogressive between 1973 and 1994. Pseudarthrosis occurred in thirteen feet. Thirty feet or ankles (45 percent) were painful at the first follow-up evaluation, and thirty-seven feet or ankles (55 percent) were painful at the second follow-up evaluation. Of the thirty feet or ankles that were painful at the first follow-up evaluation, twenty-three were painful at the second follow-up evaluation. Of the thirty-seven feet or ankles that were not painful at the first follow-up evaluation, fourteen were painful at the second follow-up evaluation. Eighteen patients (32 percent) needed walking support at the time of the first follow-up, and thirty-nine patients (68 percent) needed it at the time of the second follow-up. Two of the patients who needed support at the first follow-up evaluation did not need it at the second follow-up evaluation. At the first follow-up evaluation, twenty-one ankles (31 percent) had no radiographic evidence of degenerative changes. However, by the second follow-up evaluation, all of the ankles had some degenerative changes. Similar progressive arthritic findings were noted at the naviculocuneiform and tarsometatarsal joints. According to the system of Angus and Cowell, the overall result at the time of the first follow-up was rated as good in fifty feet (75 percent) and as fair in seventeen feet (25 percent). At the time of the second follow-up, nineteen feet (28 percent) were rated as good, forty-six (69 percent) were rated as fair, and two (3 percent) were rated as poor. CONCLUSIONS: Despite progressive symptoms and radiographic degeneration in the joints of the ankle and midfoot, fifty-four patients (95 percent) were satisfied with the result of the operation. The triple arthrodesis was a satisfactory solution for imbalance of the hindfoot in this group of patients.     

Trephine arthrodesis of subtalar joints: operative tech-nique and clinical effect

Objective: To review the operative technique of tre-phine arthrodesis of subtalar joints and evaluate its clinical effect.Methods: From June 1998 to October 2006, we per-formed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.Results: No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average anlde-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range,1 to 6) post-operatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing.Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Post-operative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavieular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolaterai approach, which required revision arthrodesis.Conclusion: Isolated subtalar arthrodesis with tre-phine method is an effective procedure for painful malalignment of hindfoot.     

Ankle Valgus after Hindfoot Arthrodesis: A Radiographic and Chart Comparison of the Medial Double and Triple Arthrodeses

The medial double arthrodesis, comprised of subtalar and talonavicular joint fusions, has become a popular way to correct hindfoot deformity. There is potential concern for an increase in ankle valgus postoperatively owing to extended medial dissection and possible disruption of the deltoid ligament. Although this approach is often used to correct a valgus hindfoot, little attention has been paid to date on this procedure’s effect on the tibiotalar joint. Although the medial double arthrodesis has been shown to produce reproducible outcomes without violating the lateral hindfoot structures, our hypothesis was that this approach would increase the ankle valgus deformity compared with its triple counterpart. The primary goal of the present retrospective study was to identify the frequency and severity of ankle valgus after the medial double arthrodesis compared with the triple arthrodesis. A total of 77 patients (78 feet) met our inclusion criteria. Their mean age was 61.3 ± 10.7 (range 27 to 79) years, and the follow-up period was 15.7 ± 9.9 (range 6 to 46) months. There were 16 and 61 patients (62 feet) in the medial double and triple arthrodesis groups, respectively. Overall, the preoperative ankle valgus was 1.24° ± 2.02° (range 0° to 6°), and there was no statistical difference of preoperative ankle valgus noted between groups (p = .060). Collectively, postoperative ankle valgus was 3.01° ± 3.54° (0° to 17°) with an increase in ankle valgus in 4 of 16 medial double and 34 of 62 triple arthrodesis patients. With a mean follow-up of 8.75 ± 4.02 (6 to 21) months, the medial double arthrodesis cohort's ankle valgus increased from 0.5° ± 1.55° (0° to 6°) to 1.5° ± 3.14° (1° to 10°) postoperatively. The triple arthrodesis group had a mean follow-up 17.53 ± 10.17 (6 to 46) months and ankle valgus increased from 1.44° ± 2.09° (0 to 6°) to 3.40° ± 3.56° (0° to 17°). Postoperative ankle valgus was statistically significant between groups (U = 303.50, p = .013). The odds of having an increase in the valgus ankle angle for patients in the triple group was 3.64 times that for patients in the double group, while holding all other variables in the model constant.     

足弓的生物力学原理及其临床应用

目的分析足弓的生物力学原理及在临床的应用。方法采用二次抛物拱的原理来分析和计算足部纵弓的受力状态。结果 跖筋膜相当于抛物拱的拉杆，足部的诸骨组成了内、外侧纵弓，有拉杆的抛物拱稳定，无拉杆的不稳定，后者的受力由拱变成梁的受力。从２４０只马蹄足三关节融合术后，复查到１５６只足，其中３４例在三关节融合时切断跖筋膜，石膏固定３个月拆除后下地步行，１～２年后出现步行疼痛，中跗关节着地行走，足弓消失。其中１８例重做三关节融合，跖筋膜紧束， １０例作跟骨截骨，跖筋膜重建术，效果满意。结论　要使三关节融合术取得满意效果，必须做到重建弓，正确处理跖筋膜，达到周围肌力的平衡。     

Functional outcome and gait analysis after triple or double arthrodesis.

Thirteen patients who had undergone unilateral triple or double arthrodesis were studied an average of 5.2 years after surgery. Patients with a neuromuscular disorder; inflammatory arthritis; or any other focus of lower extremity arthritis, deformity, or joint dysfunction were excluded from the study. Clinical and radiological assessment of the patients was performed in addition to three-dimensional kinematic and kinetic gait analysis. Objective clinical outcome based on the American Orthopaedic Ankle and Foot Society score was rated as good or excellent for 10 patients, fair for 2, and poor for 1. Two patients developed radiological evidence of arthrosis affecting other tarsal joints that was not apparent on preoperative radiographs. Two other patients had some progression of radiological arthrosis that was identified before the index surgery. The presence of radiological ankle or tarsal arthritis did not correlate with the level of the patient's pain or functional disability. Gait analysis demonstrated a 13% increase in range of flexion of the ipsilateral knee during the third rocker period of stance. At the ankle, range of motion during the same period of stance was reduced by 33%. This was mostly the result of a 6 degrees (53%) loss of plantarflexion at toe-off. Analysis of the ankle kinetic data identified a mean 13% reduction in the peak external ankle dorsiflexion moment and a 45% reduction in mean maximum power generation at the ankle in comparison to the normal side. Unilateral triple or double arthrodesis was shown to predictably result in decreased pain and increased function in otherwise normal individuals.     

Triple arthrodesis by inlay grafting--a method suitable for the undeformed or valgus foot.

A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot, cerebral palsy and spina bifida. The operation was successful in controlling deformity and pain. The only significant complication was failure of fusion of the midtarsal joint which occurred in three of eighty-five feet (3-5%).     

Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation

Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion. In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031). We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant relief of pain and improvement in function.