中国修复重建外科杂志

中国修复重建外科杂志

距舟关节融合联合跟骨截骨治疗 Müller-Weiss 病的早期疗效

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目的 探讨距舟关节融合联合跟骨截骨治疗 Müller-Weiss 病的早期疗效。 方法 2015 年 6 月—2017 年 2 月,对 14 例(14 足)保守治疗无效的 Müller-Weiss 病患者行距舟关节融合联合跟骨截骨治疗。男 3 例,女 11 例;年龄 35~56 岁,平均 46.2 岁。左足 6 例,右足 8 例。Maceira 分期:Ⅲ期 5 例,Ⅳ期 9 例。病程 4~12 年,平均 7 年。术前摄 X 线片测量 Saltzman 位后足力线为(9.8±2.8)°,侧位跟骨倾斜角(calcaneal pitch angle,CPA)为(14.7±5.1)°,侧位距骨第 1 跖骨角(Meary 角)为(4.8±2.8)°,正位距骨第 1 跖骨角(talar 1 meta-tarsal angle,T1MA)为(25.0±7.3)°;无邻近关节骨关节炎。术前疼痛视觉模拟评分(VAS)为(5.9±1.5)分,美国矫形外科足踝协会踝与后足评分(AOFAS)为(58.8±17.6)分。 结果 患者均获随访,随访时间 14~27 个月,平均 22.3 个月。术后 2 例出现足内侧麻木感,2 例切口感染;其余患者无明显不适。末次随访时,VAS 评分为(1.6±1.3)分,AOFAS 评分为(90.6±2.7)分,均较术前明显改善(t=8.18,P=0.00;t=–6.95,P=0.00)。X 线片复查示,患者距舟关节及跟骨截骨均达骨性愈合;测量 Saltzman 位后足力线为(–2.5±2.7)°,侧位 CPA 为(25.0±5.2)°、Meary 角为(2.6±2.1)°,正位 T1MA 为(8.1±3.8)°;除 Meary 角与术前比较差异无统计学意义(t=1.53,P=0.15)外,Saltzman 位后足力线、CPA、T1MA 与术前比较差异均有统计学意义(t=11.93,P=0.00;t=–8.89,P=0.00;t=8.05,P=0.00)。 结论 对于保守治疗无效且无邻近关节骨关节炎的 Müller-Weiss 病患者,采用距舟关节融合联合跟骨截骨治疗可获得较好的早期疗效。

Objective To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease. Methods Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years (range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years (mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was (9.8±2.8)°, calcaneal pitch angle (CPA) on lateral position was (14.7±5.1)°, Meary angle on lateral position was (4.8±2.8)°, and talar 1 meta-tarsal angle (T1MA) on anteroposterior position was (25.0±7.3)°. Preoperative visual analogue scale (VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot score was 58.8±17.6. Results All patients were followed up 14-27 months (mean, 22.3 months). Medial numbness and incision infection occurred in 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showing significant difference when compared with preoperative ones (t=8.18, P=0.00; t=–6.95, P=0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was (–2.5±2.7)°, CPA on lateral position was (25.0±5.2) °, Meary angle on lateral position was (2.6±2.1)°, T1MA on anteroposterior position was (8.1±3.8)°. There was no significant difference in Meary Angle between pre- and post-operation (t=1.53, P=0.15). And there were significant differences in the hindfoot axis, CPA, and T1MA showed significant differences between pre- and post-operation (t=11.93, P=0.00; t=-8.89, P=0.00; t=8.05, P=0.00). Conclusion The short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy is good for Müller-Weiss disease patients without adjacent joint arthritis who are ineffective on conservative treatment.

关键词: Müller-Weiss 病; 距舟关节; 关节融合; 跟骨截骨

Key words: Müller-Weiss disease; talonavicular joint; arthrodesis; calcaneus osteotomy

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