摘要目的 探讨三关节截骨矫形融合治疗ⅡB和Ⅲ期成年人获得性平足症的疗效.方法 2008年1月至2009年12月采用距下、距舟和跟骰三关节截骨矫形融合治疗10例(ⅡB3例、Ⅲ期7例)成年人获得性平足症患者.手术取内外侧联合人路显露距下、距舟和跟骰关节;完整去除关节软骨;予以适当截骨矫形、维持足于理想位置并用克氏针临时固定.选用两枚直径7.3 mm空心螺钉固定距下关节;再分别用两枚直径4.5 mm空心螺钉由远及近固定距舟关节和跟骰关节.术前、术后采用AOFAS功能评分表进行疗效分析,同时观察疼痛缓解、功能、外观及满意度等.影像学评估包括骨愈合时间,前后位距骨-第1跖骨角、侧位跟距角、侧位距骨-第1跖骨角等.结果 10例患者术后全部获得随防,平均随访13.2个月(6～21个月).AOFAS功能评分从术前平均(39.4±4.4)分升高到术后(83.7 ±2.6)分,所有病人在疼痛、功能及外观上均有改善,对治疗结果满意.X线片显示:距下、距舟和跟骰关节均达到骨性愈合;前后位距骨-第1跖骨角、侧位跟距角、侧位距骨-第1跖骨角等均有显著改善.本组没有发现伤口感染、骨不连等并发症.结论 三关节截骨矫形融合是一种治疗ⅡB和Ⅲ期成年人获得性平足症的理想手术,可以明显缓解疼痛,有效矫正畸形,获得较好的临床疗效.

abstractsObjective To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage ⅡB and Stage Ⅲ adult-acquired flatfoot. Methods The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage ⅡB adult-acquired flatfoot and 7 cases of stage Ⅲ adultacquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ),talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomied to restore their proper alignments. The optimal positioning of hindfoot could be gchieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses. Results All patients were followedup with a mean time of 13.2 (6-21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2. 6 postoperatively ( P ＜ 0.01 ). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied.Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle,lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported. Conclusion Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage ⅡB and Ⅲ adult-acquired flatfoot deformity. It may relieve pains,correct structural deformities and obtain excellent clinical outcomes.