高弓马蹄内翻足术后复发与跟骨截骨

目的 探讨高弓内翻足手术治疗后的内翻复发,跟骨截骨外移的矫正度与内翻复发的关系.方法 23例(31足)成人高弓内翻足患者,年龄13～59岁,平均36岁.以术前Coleman试验可否矫正、经内侧软组织和(或)肌腱松解后后足内翻被动矫正情况以及是否行跟骨截骨,将患足分为4组.并以被动可矫正至中立位和外翻5°以上为两个界限.进行统计.跟骨截骨可以为跟骨轴位水平方向上的截骨外移,截骨外移后的欠状面上的上移,以及跟骨的楔形闭合截骨.结果 内翻复发9足,5°以下5足,5°以上4足,平均4.23°±2.15°.末行跟骨截骨12足中,术前Coleman试验可矫正至中立位3足均复发,术前Coleman试验可矫正至外翻5°以上的4足均未复发.术前Coleman试验不町矫正,术中经软组织松解后可矫正至中立位的2足,术后均复发;术前Coleman试验不可矫正,术中可矫正至外翻5°以上的3足,内翻复发1足.行跟骨外移截骨19足中,术前Coleman试验可矫正至中立位9足,1足内翻复发;术前Coleman试验不可矫正,术中可矫正至中立位的7足,术后2足复发;术前Coleman试验不可矫正,术中可矫正至外翻5°以上者3足,无内翻复发.结论 Coleman试验能否矫正后足的内翻,并非是否行跟骨外移截骨术的依据;而被动手法矫正是判断是否行跟骨截骨的关键,外翻5°是一个重要的指标.

The recurring of varus and the lateral shift calcaneal osteotomy in the treatment of cavovarus foot

Objective To discuss the recurring of varus in the treatment of cavovarus foot and the relationship between correcting degree of lateral shift calcaneal osteotomy and the recurring rate.Methods Twenty-three patients (31 feet) with cavovarus foot were treated, which included 9 males and 14 females.According to the Coleman block test before the surgery, the manual passive correcting degree after the medial soft tissue release and/or the tendon lengthening and whether the calcaneal osteotomy were done, and the feet were divided into four groups.There were 0° and beyond 5° two levels of passive valgus for further differentiating and statistically analysis.The calcaneal osteotomy included lateralizing sliding osteotomy, posterior osteotomy and closing wedge osteotomy.Results In the effective following-up of 31 feet, hind foot varus recurred in 9 feet.Five varus were below 5° and 4 varus beyond 5°.The value is 4.23°±2.15°.The varus recurred in 3 feet without calcaneal osteotomy, whose Coleman block test before the surgery could correct the foot to neutral position.The varus did not recur in 4 feet without calcaneal osteotomy whose Coleman block test could correct the foot to more than 5° valgus.If the Coleman block test could not correct varus before the surgery, the varus recurred in 2 feet which could be corrected to neutral position after medial soft tissue release, while only one recurred varus in 3 feet which could be corrected to more than 5 valgus after medial soft tissue release.For the 19 feet with calcaneal osteotomy, one varus recurred in 9 feet which Coleman block test could correct the hind foot into neutral position, two varus recurred in 7 feet which Coleman block test could not correct the varus before the surgery but could correct to neutral position after the medial soft tissue release, no one varus recurred in 3 feet which Coleman block test could not correct the varus before the surgery but could correct to more than 5° valgus after the medial soft tissue release.Conclusion Whether or not the Coleman block test can correct the varus of hind foot, it can not give us the indication of calcaneal lateral sliding osteotomy.Passive manually correcting the hind foot varus is the key of judgement to do the calcaneal osteotomy.Passive valgus 5° is an important guideline.