摘要目的 对比研究跟骨后上结节切除与跟骨体闭合楔形截骨治疗Haglund综合征的临床疗效.方法 回顾分析2009年2月至2014年7月第三军医大学西南医院骨科运动医学中心共纳入Haglund综合征患者36例.分为两组,每组各18例患者.分别采用跟骨后上结节切除术或者跟骨体闭合楔形截骨术.于术前及术后6个月采集患者的影像学资料,收集患者术前及术后6、12、24个月随访的踝与后足功能问卷评分(VISA-A)、美国骨科足踝外科协会(AOFAS)踝-后足评分、Maryland足部评分及视觉模拟评分(VAS)评价,运用SPSS软件对数据进行分析.结果 手术后6个月,站立位X线片图像显示跟骨后上结节切除术不改变跟骨Fowler-Philip角、跟骨后倾角,而跟骨体闭合楔形截骨术显著减少跟骨的Fowler-Philip角、跟骨后倾角[Fowler-Philip角由术前(56.5±5.4)°减小到术后(48.4±4.6)°,跟骨倾斜角从(120.0±1.3)°减小到(109.0±5.3)°].跟骨体闭合楔形截骨组的AOFAS评分、VAS评分、VISA-A问卷评分和Maryland足评分较跟骨后上结节切除组差.术后12个月,两组间的VAS评分和Maryland评分差异无统计学意义(P>0.05),而AOFAS评分和VISA-A问卷评分方面跟骨体闭合楔形截骨组优于跟骨后上结节切除组.术后24个月,跟骨体闭合楔形截骨组的AOFAS评分、VAS评分、VISA-A问卷评分和Maryland足评分优于跟骨后上结节切除组(P<0.05).结论 跟骨后上结节切除术与跟骨体闭合楔形截骨术均能显著减轻患者的疼痛症状并改善足踝功能,但跟骨体闭合楔形截骨术能减小跟骨体Fowler-Philip角、跟骨后倾角在长期疗效方面优于跟骨后上结节切除术.

abstractsObjective To compare the clinical outcome of removal of calcaneal posterior -superior prominence and that of calcaneal closing-wedge osteotomy for Haglund syndrome .Methods From February 2009 to July 2014,36 patients with Haglund syndrome were included .They were divided into two groups ,and each group included 18 patients and underwent removal of calcaneal posterior-superior prominence and calcaneal closing-wedge osteotomy respectively .They were evaluated preoperatively and after 6 , 12 months and 24 months postoperatively by American Orthopedic Foot &Ankle Society (AOFAS) score, VAS score, VISA-A questionnaire and Maryland Foot Score .Fowler-Philip angle and calcaneal posterior slope of the two groups were compared preoperatively and after 6 months.All data were analysis utilizing SPSS 18.0.Results At six months of follow-up, the weight-bearing lateral X-rays reveals that removal of calcaneal posterior-superior prominence did not change Fowler-Philip angle and calcaneal posterior slope and calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope significantly [ from preoperation ( 56.5 ±5.4 ) °, ( 120.0 ±1.3 ) °to postoperation ( 48.4 ±4.6 ) °, ( 109.0 ±5.3 ) °] .At six months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were worse in the wedge calcaneal osteotomy group .At twelve months of follow-up, no significant difference ( P>0.05 ) was found between the two groups in terms of VAS score , and Maryland Foot Score , while the AOFAS score , and VISA-A questionnaire in the wedge calcaneal osteotomy group were better than those of posterior -superior prominence removal group.At twenty-four months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were better in the wedge calcaneal osteotomy group (P<0.05). Conclusions Both the two surgical methods are effective for Haglund syndrome .Calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope of calcaneus and its clinical outcome appears better than that removal of calcaneal posterior-superior prominence .