采用Evans跟骨延长术治疗儿童特发性痛性扁平足

目的 评价儿童痛性扁平足Evans跟骨延长术的矫正作用和效果.方法 患儿入选标准:负重及非负重情况下足内侧纵弓均降低或消失且合并疼痛症状者.本组自2006年1月至2008年7月共治疗18人23足,男11人,女7人,年龄11～14岁,平均12岁8个月,采用Evans跟骨截骨延长术进行治疗,平均随诊2年5个月,范围7个月至3年3个月,均为特发性病例,以前均进行过保守治疗且无效.术前、术后均拍照负重下前后位及侧位X线片,临床评价采用Dogan标准,X线评价包括7个参数,对术前、术后各项均值进行成组的t检验,P<0.05被认为差异有统计学意义.结果 临床评价优22足(96%),良1足(4%).术前与术后、术前与末次随访时各项X线参数的均值差异都存在统计学意义,且术后各项指标均数都在相应年龄段的正常值范围内.术后8周跟骨延长处开始愈合,术后1年塑形完成.跟骨平均延长8.0 mm(范围5～10 mm).未发生植骨块移动,无过度矫正,术后所有患儿均恢复正常跖行足负重行走.结论 对于有症状的儿童扁平足,保守治疗无效时,采用跟骨截骨延长术可以从临床和X线两个方面有效地矫正后足和前足畸形并缓解疼痛.

Evans calcaneal lengthening osteotomy for treatment of symptomatic pes planovalgus in children

Objective To evaluate the results of modified Evans osteotomy technique for treatment of symptomatic pes planovalgus in children. Methods Criteria for inclusion in the study were the symptomatic patients whose loot's medial longitudinal arch was lowered or lost. Caleaneal lengthening osteotomy was performed using the modified Evans technique in 23 feet of 18 patients (11 males, 7 females) during Jan. of 2006 to Jul. of 2008, five patients had bilateral involvement. The mean followup was 2 years 5 months (range 7 months to 3 years and 3 months). All were idiopathic, and received long-term conservative therapy preoperatively. Anteroposterior and lateral radiographs of the feet with weight bearing were made at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Clinical and radiographic assessment was based on the Dogan system. Radiographic measurements obtained at these times were compared Results Radiographically, union was achieved in all the patients after 8 weeks. Clinical results were perfect in 22 feet (96%), good in one foot (4%). There were significant changes in every measured angle on the anteroposterior or lateral radiographs between the preoperation and the latest follow-up. An average of 8.0 mm (range 5 to 10 mm) of calcaneal lengthening was obtained. Malpositioning of the graft or overcorrection did not occur. All the patients restored the weight bearing of plantigrade foot. Conclusions Calcaneal lengthening osteotomy for symptomatic pes planovalgus provides pain relief and significant clinical and radiographic correction in the hind foot and forefoot.