摘要
目的探讨距下关节融合术治疗伴有腓骨肌挛缩的跗骨窦综合征的长期临床疗效。方法回顾性分析2006年1月至2016年12月期间共32例经距下关节融合术治疗的跗骨窦综合征合并腓骨肌挛缩患者资料,其中男19例,女13例,年龄(29.3±10.9)岁(范围13~56岁),病程(2.1±1.7)年(范围1~10年)。所有患者均表现为跗骨窦疼痛和腓骨肌腱痉挛;25例病因为踝关节扭伤,4例下肢神经损伤,3例原因不明。根据患者的初始症状分为三组:单纯腓骨肌挛缩患者,先行跗骨窦清理,症状复发后行距下关节融合(清理+融合组);腓骨肌挛缩合并其他症状者,先行跗骨窦清理和其它对症手术,症状复发后行距下关节融合(清理+对症+融合组);腓骨肌痉挛性平足患者,直接行距下关节融合(直接融合组)。分别评估术前和术后美国骨科足踝外科学会(American Orthopaedic Foot&Ankle Society,AOFAS)的踝与后足评分,日常活动中疼痛的视觉模拟评分(visual analogue scale,VAS)以及36个项目的简短健康状况调查(short-form 36 item health survey,SF-36)评分。结果32例均顺利完成手术,中位随访时间87(40,133)个月。清理+融合组14例,先予以跗骨窦清理,术后平均7.7个月复发,行距下关节融合;清理+对症+融合组15例,除跗骨窦清理外,3例行跗骨联合切除,3例行跗骨窦失神经支配,6例行距下关节稳定,3例行腓骨肌腱松解,术后平均6.4个月症状复发,最终行距下关节融合术;直接融合组3例,初始症状严重,表现为腓骨肌痉挛引起的僵硬性平足,直接行距下关节融合。32例的AOFAS踝与后足平均评分从术前(27.86±10.79)分增至末次随访(86.34±7.17)分,差异有统计学意义(t=23.505,P<0.05);VAS评分从术前(8.00±1.57)分降至末次随访(1.91±1.06)分,差异有统计学意义(t=18.407,P<0.05);SF-36评分从术前(35.84±12.12)分升至末次随访(86.20±10.32)分,差异有统计学意义(t=24.203,P<0.05)。结论伴有腓骨肌挛缩的跗骨窦综合征由于复杂的病因和发病机制,可优先选择跗骨窦清理或联合对症手术方法;如果症状复发,选择距下关节融合术,可以最终获得长期疗效。
Objective To explore the long-term clinical efficacy of subtalar arthrodesis for treating sinus tarsi syndrome(STS)with peroneal spasm.Methods Clinical informationof 32 patients with sinus tarsi syndrome complicated with peroneal spasm who were treated by subtalar arthrodesis from January 2006 to December 2016 was retrospectively analysed.There were 19 males and 13 females,aged 29.3±10.9 y(range:13-56 y),and course of disease is 2.1±1.7 y(range:1-10 y).All patients suffered from tarsal sinus pain and intractable peroneal spasm.The aetiology was foot or ankle inversion sprainin 25 patients,lower limb nerve injury in four patients,and ambiguous causes in three patients.The patients were divided into three groups according to their initial symptoms.Group A:Patients with simple peroneal spasm underwent tarsal sinus debridement firstly and subtalar joint fusion after symptom recurrence.Group B:Patients with peroneal spasm combined with other symptomsunderwent sinus tarsal cleansing and other symptomatic operations,and received subtalar joint fusion after symptoms recurred.Group C:Patients with peroneal spastic flat foot were treated withsubtalar joint fusion directly.Preoperative and postoperative American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scores,visual analogue scale(VAS)scores for pain during daily activities,and 36-item short form health survey(SF-36)scoreswere investigated.Results 32 cases were successfully completed operation,following-up 87(40,133)months.Group A(14 cases):The patients were treated withsinus tarsi debridement first.But their symptoms recurred in an average of 7.7 months after surgery.Later they received subtalar joint fusion.Group B(15 cases):In addition to tarsal sinus debridement,3 cases were undergone tarsal coalitions resection,3 cases were got denervation of tarsal sinus,6 cases were received subtalar joint stabilization,and 3 cases were released their peroneal tendons.Their symptoms recurred in an average of 6.4 months after surgery,and they eventually were undergone subtalar arthrodesis.Group C(3 cases):Their initial symptoms were severe,manifested as rigid flat feet caused by peroneal tendons spasm,so they directly underwent subtalar joint fusion.The average AOFAS ankle and hindfoot scores for all patients increased from 27.86±10.79 points before treatment to 86.34±7.17 points at the last follow-up after operation(t=23.505,P<0.05).The VAS scores decreased from 8.00±1.57 points before treatment to 1.91±1.06 points at the last follow-up after operation(t=18.407,P<0.05).The SF-36 scores increased from 35.84±12.12 points before treatment to 86.20±10.32 points at the last follow-up after operation(t=24.203,P<0.05).Conclusion Sinus tarsi syndrome with peroneal spasm due to its complicated etiology and pathogenesis can give priority to sinus tarsal debridement or other symptomatic surgeries.If the symptoms recur,subtalar arthrodesis can be an alternative choice to achieve the long-term effects.
作者
杨崇林
徐向阳
黄强
郭常军
李星辰
Yang Chonglin;Xu xiangyang;Huang qiang;Guo Changjun;Li Xingchen(Department of Orthopedics,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201801,China)
出处
《中华骨科杂志》
CSCD
北大核心
2021年第16期1134-1143,共10页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81772372)
上海市嘉定区卫生健康委员会科研课题(2020-QN-01)
上海交通大学医学院附属瑞金医院北院研究基金(2020ZY16)。
关键词
踝关节
关节融合术
挛缩
复发
对比研究
Ankle joint
Arthrodesis
Contracture
Recurrence
Comparative study
