中国修复重建外科杂志

中国修复重建外科杂志

单纯距舟关节融合术治疗 Müller-Weiss 病疗效分析

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目的 评估单纯距舟关节融合术治疗 Müller-Weiss 病的早期疗效。 方法 2013 年 5 月—2015 年 2 月,采用单纯距舟关节融合术治疗 Müller-Weiss 病 13 例。其中男 2 例,女 11 例;年龄 42~67 岁,平均 59 岁。病程 8~20 年,平均 13 年。根据 Maceira 分期:Ⅲ期 7 例,Ⅳ期 6 例。术前患足负重位 X 线片测量足弓高度为(43.1±1.8)mm;侧位 X 线片测量 Meary 角为(–2.8±2.3)°,距跟角为(5.8±2.4)°;Saltzman 位 X 线片测量跟骨外翻角为(–2.0±0.7)°。术前美国矫形足踝协会(AOFAS)中足评分为(43.5±12.4)分,疼痛视觉模拟评分(VAS)为(7.3±1.5)分。 结果 患者均获随访,随访时间 14~39 个月,平均 20 个月。患足疼痛及间歇性跛行等症状均消失,距舟关节均骨性融合,融合时间 12~16 周,平均 13 周。术后无切口感染、皮肤坏死、内固定物断裂等并发症发生。末次随访时,足弓高度、Meary 角、距跟角和跟骨外翻角分别为(52.5±2.2)mm、(1.3±2.2)°、(16.5±3.7)°、(0.4±0.7)°,AOFAS 中足评分为(83.8±9.1)分,VAS 评分为(1.0±0.4)分,均较术前显著改善,差异有统计学意义(P<0.05)。 结论 对于保守治疗无效的 Müller-Weiss 病患者,如距下关节和跟骰关节受累较少,单纯距舟关节融合术是一种可靠、有效的治疗方法。

Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (–2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (–2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones (P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.

关键词: Müller-Weiss 病; 舟骨; 距舟关节; 关节融合术

Key words: Müller-Weiss disease; navicular bone; talonavicular joint; arthrodesis

引用本文: 胡东, 张言, 梁晓军, 李毅, 赵宏谋. 单纯距舟关节融合术治疗 Müller-Weiss 病疗效分析. 中国修复重建外科杂志, 2017, 31(12): 1434-1437. doi: 10.7507/1002-1892.201703052 复制

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1. Fornaciari P, Gilgen A, Zwicky L, et al. Isolated talonavicular fusion with tension band for Müller-Weiss syndrome. Foot Ankle Int, 2014, 35(12): 1316-1322.
2. Samim M, Moukaddam HA, Smitaman E. Imaging of Müller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum. AJR Am J Roentgenol, 2016, 207(2): W8-W18.
3. Maceira E, Rochera R. Müller-Weiss disease: clinical and biomechanical features. Foot Ankle Clin, 2004, 9(1): 105-125.
4. Li SY, Myerson MS, Monteagudo M, et al. Efficacy of Calcaneus Osteotomy for Treatment of Symptomatic Müller-Weiss Disease. Foot Ankle Int, 2017, 38(3): 261-269.
5. Mohiuddin T, Jennison T, Damany D. Müller-Weiss disease——review of current knowledge. Foot Ankle Surg, 2014, 20(2): 79-84.
6. Cao HH, Tang KL, Xu JZ. Peri-navicular arthrodesis for the Stage III Müller-Weiss disease. Foot Ankle Int, 2012, 33(6): 475-478.
7. Fernándezd de Retana P, Maceira E, Fernández-Valencia JA, et al. Arthrodesis of the talonavicular-cuneiform joints in Müller-Weiss disease. Foot Ankle Clin, 2004, 9(1): 65-72.
8. Lui TH. Arthroscopic triple arthrodesis in patients with Müller Weiss disease. Foot Ankle Surg, 2009, 15(3): 119-122.
9. Reade B, Atlas G, Distazio J, et al. Müller-Weiss syndrome: an uncommon cause of midfoot pain. J Foot Ankle Surg, 1998, 37(6): 535-539.
10. Lu CK, Fu YC, Cheng YM, et al. Isolated talonavicular arthrodesis for Müller-Weiss disease. Kaohsiung J Med Sci, 2014, 30(9): 471-476.
11. Ma S, Jin D. Isolated Talonavicular Arthrodesis. Foot Ankle Int, 2016, 37(8): 905-908.
12. 马盛辉, 金丹. 单纯距舟关节融合手术疗效及其并发症的研究进展. 中华创伤杂志, 2015, 31(2): 121-123.
13. Higgs Z, Jamal B, Fogg QA, et al. An anatomical study comparing two surgical approaches for isolated talonavicular arthrodesis. Foot Ankle Int, 2014, 35(10): 1063-1067.
14. Granata JD, Berlet GC, Ghotge R, et al. Talonavicular joint fixation: a biomechanical comparison of locking compression plates and lag screws. Foot Ankle Spec, 2014, 7(1): 20-31.
15. Chatellard R, Berhouet J, Brilhault J. Efficiency of locking-plate fixation in isolated talonavicular fusion. Orthop Traumatol Surg Res, 2016, 102(4 Suppl): S235-S239.