Evans跟骨外侧延长截骨术治疗青少年距跟联合合并前足外展畸形

目的探讨Evans跟骨外侧延长截骨术并联合切除治疗青少年距跟联合(TCCs)合并严重前足外展畸形的疗效。方法回顾性分析郑州市骨科医院足踝外科自2014年2月至2018年8月收治的11例(14足)青少年症状性TCCs合并严重前足外展畸形患者资料。男6例(8足),女5例(6足);双足3例,单足8例,左足7例,右足7例;年龄13~17岁,平均15岁。所有患者均采取TCCs切除后行Evans跟骨外侧延长截骨术。测量患者术前及末次随访时负重正位X线距舟覆盖角(TCA)、距骨-第2跖列角(T-2MT),负重侧位X线距骨倾斜角(TH)、距骨-第1跖列角(T-1MT)。采用美国足踝外科协会(AOFAS)的踝-后足评分和疼痛视觉模拟评分(VAS)评估足部功能和疼痛改善情况。结果11例患者术后获12~24个月(平均16.5个月)随访。TCA由术前平均22.3°(20°~26°)改善为末次随访时10.5°(8°~13°);T-2MT由术前平均17.6°(16°~20°)改善为末次随访时6.5°(5°~11°)。侧位X线TH由术前平均35°(25°~40°)改善为末次随访时17.5°(16°~21°);T-1MT由术前平均15.5°(10°~22°)改善为末次随访时3.5°(2°~6°)。AOFAS的踝-后足评分由术前平均56.5分(50~62分)改善为末次随访时90.6分(75~95分),VAS评分由术前平均6.0分(5~7分)改善为末次随访时2.0分(0~3分)。结论对于青少年TCCs合并严重前足外展畸形患者,联合切除后行Evans跟骨外侧延长截骨术可以有效纠正畸形,缓解症状,改善足部功能和影像学表现。

Evans lateral lengthening calcaneal osteotomy for talocalcaneal coalitions with forefoot abduction deformity in the teenagers

Objective To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT)in the treatment of talocalcaneal coalitions(TCCs)with forefoot abduction deformity in the teenagers.Methods From February 2014 to August 2018,11 teenaged patients(14 feet)were treated at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity.They were 6 males(8 feet)and 5 females(6 feet),aged from 13 to 17 years(average,15 years).Their diseases involved bilateral feet in 3 cases and unilateral foot in 8,the left foot in 7 cases and the right in 7.All patients underwent TCCs resection followed by E-LLCOT.Their talonavicular coverage angles(TCA)and talar-second metatarsal angles(T2-MT)on the anteroposterior film and talar horizontal angles(TH)and talar-first metatarsal angles(T1-MT)on the lateral film were measured preoperatively and at the last follow-up.The foot functions were evaluated preoperatively and at the last follow-up using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS)and visual analogue scale(VAS).Results All the 11 patients were followed up for 12 to 24 months(average,16.5 months).The mean preoperative TCA(22.3°,from 20°to 26°)was improved to 10.5°(from 8°to 13°)at the last follow-up;the mean T-2MT was improved from preoperative 17.6°(from 16°to 20°)to 6.5°(from 5°to 11°)at the last follow-up;the mean TH on the lateral view was improved from preoperative 35°(from 25°to 40°)to 17.5°(from 16°to 21°)at the last follow-up;the mean T-1MT was improved from preoperative 15.5°(from 10°to 22°)to 3.5°(from 2°to 6°)at the last follow-up;the mean AOFAS score was improved from 56.5(from 50 to 62)preoperatively to 90.6(from 75 to 95)at the last follow-up;the mean VAS score was improved from 6.0(from 5 to 7)preoperatively to 2(from 0 to 3)at the last follow-up.Conclusion For TCCs with severe forefoot abduction deformity in the geenagers,E-LLCOT after TCCs resection can effectively correct deformity,relieve pain and achieve significant functional and radiographic improvements.