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。

Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity

Objective To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy(ELLCOT)in treatment of talocalcaneal coalition(TCC)with hindfoot valgus deformity.Methods Between January 2014 and October 2017,10 patients(13 feet)of TCC with hindfoot valgus deformities underwent E-LLCOTs.There were 6 males(8 feet)and 4 females(5 feet)with an age of 13-18 years(mean,15.8 years).The disease duration was 10-14 months(mean,11.5 months).The foot deformity was characterized by hindfoot valgus,forefoot abduction,and collapse of the medial arch.Pain site was the tarsal sinus in 4 feet,TCC in 5 feet,and ankle joint in 4 feet.There were tightness of the gastrocnemius in 3 cases(4 feet)and Achilles tendon in 7 cases(9 feet)on Silverskiold test.The preoperative American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was 46.54±9.08 and visual analogue scale(VAS)score was 6.54±0.88 after walking 1 kilometer.The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot.The talar-first metatarsal angle(T1 MT),talonavicular coverage angle(TCA),talarhorizontal angle(TH),calcaneal pitch angle(CP),and heel valgus angle(HV)were measured after operation.Results All incisions healed by first intention.All patients were followed up 12-30 months(mean,18 months).At last follow-up,the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90,respectively,showing significant differences when compared with preoperative scores(t=-23.380,P=0.000;t=35.218,P=0.000).X-ray films showed that the osteotomy healed at 2-4 months(mean,3 months)after operation.At last follow-up,the T1 MT,TCA,TH,and HV were significantly lower than preoperative ones(P<0.05),and the CP was significantly higher than preoperative one(P<0.05).During the follow-up,the pain did not relieve obviously in 1 patient(1 foot),and the cutaneous branch of the sural nerve injured in 1 patient(1 foot).Conclusion For TCC with severe hindfoot valgus deformity,ELLCOT can effectively correct deformity and relieve pain.