摘要
背景:陈旧性Lisfranc复合体损伤往往继发中足僵硬以及创伤后平足或高弓畸形。中足截骨术矫正畸形的安全性和有效性成为焦点。目的:探讨改良JAPAS截骨治疗陈旧性Lisfranc复合体损伤继发僵硬高弓畸形的安全性、可行性及疗效。方法:回顾性分析2014年1月至2016年1月采用改良JAPAS截骨治疗的陈旧性Lisfranc复合体损伤继发僵硬高弓畸形的21例患者。收集并测量患者手术前后足部X线正、侧位片的距骨第一跖骨角(正、侧位Meary角)并对比分析冠矢双平面畸形的角度的差异性及疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)评分。结果:21例患者平均随访(36.7±7.5)个月。19例患者切口甲级愈合。2例患者发生足背切口延迟愈合。所有患者最终均达到骨性愈合,无骨不愈合以及畸形愈合。术后1例患者出现止血带麻痹,1例患者发生腓深神经损伤。末次随访时,患者疼痛VAS评分、AOFAS评分均较术前改善,正、侧位Meary角均较术前减小,且差异均有统计学意义。结论:改良的JAPAS截骨不仅可以多平面矫正陈旧Lisfranc损伤后继发僵硬高弓畸形,且操作简便,并发症少。
Background: Old Lisfranc complex injuries often lead to stiffness of the midfoot, post-traumatic flatfeet or cavus deformities. The safety and effectiveness of midfoot osteotomy to correct deformity become the focus. Objective: To explore the safety, feasibility and clinical efficacy of modified JAPAS osteotomy in the treatment of stiff cavus deformity secondary to old Lisfranc complex injury. Methods: Retrospective analysis was conducted in 21 patients with stiff cavus deformity secondary to old Lisfranc complex injury who were treated by modified JAPAS osteotomy between January 2014 and January 2016. The first metatarsal angle of the talus(Meary angle), the angle of the coronal and sagittal biplane deformity, VAS and AOFAS score before and after surgery were recorded. Results: The mean duration of follow-up was(36.7±7.5) months in the 21 patients. The incision healed in 19 patients, and delayed healing of the instep of the foot occurred in 2 patients. All patients eventually achieved bone healing, no nonunion or malunion was found. One patient developed tourniquet paralysis and one patient developed deep peroneal nerve injury. At the last follow-up, VAS and AOFAS scores were significantly improved compared with preoperative scores, both anteroposterior and lateral Meary angles were significantly smaller than preoperative angles.Conclusions: The modified JAPAS midfoot osteotomy strategy can not only correct the stiff cavus deformity secondary to old Lisfranc injury, but also has simple operation and less clinical complications.
作者
陈宇
张晖
李亚星
邓伟
刘熹
秦博泉
任毅
吴仕舟
CHEN Yu;ZHANG Hui;LI Yaxing;DENG Wei;LIU Xi;QIN Boquan;REN Yi;WU Shizhou(Department of Orthopaedic,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华骨与关节外科杂志》
2020年第7期538-542,547,共6页
Chinese Journal of Bone and Joint Surgery
