文章简介

出版社:Foot & Ankle International 34

作   者:Chan et al.

编   号:10.1177/1071100712460225

年   份:2013    点击量:1052

文章摘要

BACKGROUND:

    Successful correction of hindfoot alignment in adult acquired flatfoot deformity (AAFD) is likely influenced by the degree of medializing calcaneal osteotomy (MCO) performed, but it is not known if other reconstruction procedures significantly contribute as well. The purpose of this study was to evaluate the correlation between common preoperative and postoperative variables and hindfoot alignment.

背景:

    在成人获得性扁平足畸形(AAFD)中,后足对位的成功矫正很有可能受跟骨内移截骨术(MCO)完成程度的影响,但是,其他重建程序是否也有显著贡献尚不得而知。本研究的目的是评估术前与术后的常见变量和后足对位之间的相关性。

 

METHODS:

    Thirty patients with stage II AAFD undergoing flatfoot reconstruction were followed prospectively. Preoperative and postoperative radiographs were reviewed to assess for correction in hindfoot alignment as measured by the change in hindfoot moment arm. Nineteen variables were analyzed, including age, gender, height, weight, body mass index (BMI), medial cuneiform-fifth metatarsal height, anteroposterior (AP) talonavicular coverage, AP talus-first metatarsal, lateral talus-first metatarsal and calcaneal pitch angles as well as intraoperative use of the MCO, lateral column lengthening (LCL), Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament reconstruction, and gastrocnemius recession or Achilles lengthening. Mean age was 57.3 years (range, 22-77). Final radiographs were obtained at a mean of 47 weeks (range, 25-78) postoperatively.

方法:

    对30例接受扁平足重建的Ⅱ期AAFD患者进行了前瞻性随访。以后足力臂的变化来衡量后足对位的矫正,使用术前和术后X光片对其进行评估。对19项变量进行分析,包括年龄,性别,身高,体重,身体质量指数(BMI),内侧楔骨-第五跖骨的高度,前后位(AP)距舟覆盖率,AP距骨-第一跖骨角,侧位距骨-第一跖骨角,跟骨俯仰角以及MCO,外侧柱延长(LCL),内侧楔骨的背侧开放楔形截骨术(Cotton 截骨术),第一跗跖关节融合术,趾长屈肌腱转移术,弹簧韧带重建和腓肠肌松解或跟腱延长术的术中使用。平均年龄为57.3岁(22-77岁)。平均术后47周(25-78周)时获得最后的X光片。

 

RESULTS:

    Seven variables were found to significantly affect hindfoot moment arm. These were gender (P < .05), the amount of MCO performed (P < .001), LCL (P < .01), first tarsometatarsal fusion (P < .01), spring ligament reconstruction (P < .01), medial cuneiform-fifth metatarsal height (P < .001), and calcaneal pitch angle (P < .05). Multivariate regression analysis revealed that MCO was the only significant predictor of hindfoot moment arm. The final regression model for MCO showed a good fit (R2 = .93, P < .001).

结果:

    已发现7项变量显著影响后足力臂,包括性别(P < .05),MCO施行次数(P < .001),LCL(P < .01),第一跗跖关节融合术(P < .01),弹簧韧带重建(P < .01),内侧楔骨-第五跖骨的高度(P < .001),以及跟骨俯仰角(P < .05)。多元回归分析显示,MCO是后足力臂唯一有效的预测因素。最终回归模型显示MCO拟合度好(R2=.93,P < .001)。

 

CONCLUSION:

    Correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly. We believe that the hindfoot alignment view can serve as a valuable preoperative measurement to help surgeons adjust the proper amount of correction intraoperatively.

结论:

    扁平足重建中后足外翻对位的矫正主要由MCO程序决定,且可被线性建模。我们相信,后足对位视图用作术前测量具有一定价值,可帮助外科医生对术中矫正进行适量调整。

由MediCool医库软件 医学编辑 余娟 编译

原文来自:Foot & Ankle International