距舟关节融合联合跟骨截骨治疗Müller-Weiss病的早期疗效
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摘要
目的探讨距舟关节融合联合跟骨截骨治疗Müller-Weiss病的早期疗效。方法 2015年6月—2017年2月,对14例(14足)保守治疗无效的Müller-Weiss病患者行距舟关节融合联合跟骨截骨治疗。男3例,女11例;年龄35～56岁,平均46.2岁。左足6例,右足8例。Maceira分期:Ⅲ期5例,Ⅳ期9例。病程4～12年,平均7年。术前摄X线片测量Saltzman位后足力线为(9.8±2.8)°,侧位跟骨倾斜角(calcaneal pitch angle,CPA)为(14.7±5.1)°,侧位距骨第1跖骨角(Meary角)为(4.8±2.8)°,正位距骨第1跖骨角(talar 1 meta-tarsal angle,T1MA)为(25.0±7.3)°;无邻近关节骨关节炎。术前疼痛视觉模拟评分(VAS)为(5.9±1.5)分,美国矫形外科足踝协会踝与后足评分(AOFAS)为(58.8±17.6)分。结果患者均获随访,随访时间14～27个月,平均22.3个月。术后2例出现足内侧麻木感,2例切口感染;其余患者无明显不适。末次随访时,VAS评分为(1.6±1.3)分,AOFAS评分为(90.6±2.7)分,均较术前明显改善(t=8.18,P=0.00;t=–6.95,P=0.00)。X线片复查示,患者距舟关节及跟骨截骨均达骨性愈合;测量Saltzman位后足力线为(–2.5±2.7)°,侧位CPA为(25.0±5.2)°、Meary角为(2.6±2.1)°,正位T1MA为(8.1±3.8)°;除Meary角与术前比较差异无统计学意义(t=1.53,P=0.15)外,Saltzman位后足力线、CPA、T1MA与术前比较差异均有统计学意义(t=11.93,P=0.00;t=–8.89,P=0.00;t=8.05,P=0.00)。结论对于保守治疗无效且无邻近关节骨关节炎的Müller-Weiss病患者,采用距舟关节融合联合跟骨截骨治疗可获得较好的早期疗效。
Objective To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease. Methods Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment, were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years(range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years(mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was(9.8±2.8)°, calcaneal pitch angle(CPA)on lateral position was(14.7±5.1)°, Meary angle on lateral position was(4.8±2.8)°, and talar 1 meta-tarsal angle(T1 MA)on anteroposterior position was(25.0±7.3)°. Preoperative visual analogue scale(VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society(AOFAS) ankle-hindfoot score was 58.8±17.6. Results All patients were followed up 14-27 months(mean, 22.3 months). Medial numbness and incision infection occurred in 2, 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showingsignificant differences when compared with preoperative ones(t=8.18, P=0.00; t=–6.95, P=0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was(–2.5±2.7)°, CPA on lateral position was(25.0±5.2) °, Meary angle on lateral position was(2.6±2.1)°, T1 MA on anteroposterior position was(8.1±3.8)°. There was no significant difference in Meary Angle between pre-and post-operation(t=1.53, P=0.15). And there were significant differences in the hindfoot axis, CPA, and T1 MA between pre-and postoperation(t=11.93, P=0.00; t=–8.89, P=0.00; t=8.05, P=0.00). Conclusion For Müller-Weiss disease patients without adjacent joint arthritis, who are ineffective on conservative treatment, the satisfied short-term effectiveness can be obtained when treated by talonavicular joint arthrodesis and calcaneus osteotomy.
Objective To investigate the short-term effectiveness of talonavicular joint arthrodesis and calcaneus osteotomy in the treatment of Müller-Weiss disease. Methods Between June 2015 and February 2017, 14 patients diagnosed Müller-Weiss disease, who were ineffective on conservative treatment, were treated with talonavicular joint arthrodesis and calcaneus osteotomy. There are 3 males and 11 females, with an average age of 46.2 years(range, 35-56 years). According to the Maceira grading criteria, 5 patients were rated as stage Ⅲ and 9 patients as stage Ⅳ. The disease duration ranged from 4 to 12 years(mean, 7 years). Preoperative X-ray films showed that all patients were not accompanied with adjacent joint arthritis. The hindfoot axis on Saltzman view was(9.8±2.8)°, calcaneal pitch angle(CPA)on lateral position was(14.7±5.1)°, Meary angle on lateral position was(4.8±2.8)°, and talar 1 meta-tarsal angle(T1 MA)on anteroposterior position was(25.0±7.3)°. Preoperative visual analogue scale(VAS) score was 5.9±1.5, American Orthopedic Foot Ankle Society(AOFAS) ankle-hindfoot score was 58.8±17.6. Results All patients were followed up 14-27 months(mean, 22.3 months). Medial numbness and incision infection occurred in 2, 2 cases, respectively. The other patients had no obvious discomfort. At last follow-up, VAS score was 1.6±1.3 and AOFAS score was 90.6±2.7, showingsignificant differences when compared with preoperative ones(t=8.18, P=0.00; t=–6.95, P=0.00). X-ray films showed that the talonavicular joint and calcaneus osteotomy achieved bony healing. The hindfoot axis on Saltzman view was(–2.5±2.7)°, CPA on lateral position was(25.0±5.2) °, Meary angle on lateral position was(2.6±2.1)°, T1 MA on anteroposterior position was(8.1±3.8)°. There was no significant difference in Meary Angle between pre-and post-operation(t=1.53, P=0.15). And there were significant differences in the hindfoot axis, CPA, and T1 MA between pre-and postoperation(t=11.93, P=0.00; t=–8.89, P=0.00; t=8.05, P=0.00). Conclusion For Müller-Weiss disease patients without adjacent joint arthritis, who are ineffective on conservative treatment, the satisfied short-term effectiveness can be obtained when treated by talonavicular joint arthrodesis and calcaneus osteotomy.
引文
1 Fornaciari P, Gilgen A, Zwicky L, et al. Isolated talonavicular fusion with tension band for Muller-Weiss syndrome. Foot Ankle Int, 2014, 35(12):1316-1322.
2 Mohiuddin T, Jennison T, Damany D. Muller-Weiss diseaseReview of current knowledge. Foot Ankle Surg, 2014, 20(2):79-84.
3 Samim M,Moukaddam HA,Smitaman E. Imaging of MuellerWeiss syndrome:A review of clinical presentations and imaging spectrum. AJR Am J Roentgenol, 2016, 207(2):W8-W18.
4胡东,张言,梁晓军,等.单纯距舟关节融合术治疗Muller-Weiss病疗效分析.中国修复重建外科杂志,2017, 31(12):1434-1437.
5 Cao HH, Lu WZ, Tang KL. Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Miiller-Weiss disease. J Orthop Surg Res, 2017,12(1):83.
6 Lui TH. Arthroscopic triple arthrodesis in patients with Muller Weiss disease. Foot Ankle Surg, 2009, 15(3):119-122.
7 Janositz G, Sisak K, Toth K. Percutaneous decompression for the treatment of Mueller-Weiss syndrome. Knee Surg Sports Traumatol Arthrosc, 2011,19(4):688-690.
8 Tosun B, AI F, Tosun A. Spontaneous osteonecrosis of the tarsalnavicular in an adult:Mueller-Weiss syndrome. J Foot Ankle Surg,2011, 50(2):221-224.
9 Maceira E,Rochera R. Miiller-Weiss disease:clinical and biomechanical features. Foot Ankle Clin, 2004, 9(1):105-125.
10 Turner NM, van de Leemput AJ, Draaisma JM, et al. Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills. Med Educ, 2008, 42(5):503-511.
11 Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994,15(7):349-353.
12 Doyle T, Napier RJ, Wong-Chung J. Recognition and management of Muller-Weiss disease. Foot Ankle Int, 2012, 33(4):275-281.
13 Huson A. Biomechanics of the tarsal mechanism. A key to the function of the normal human foot. J Am Podiatr Med Assoc,2000, 90(1):12-17.
14 Prichasuk S, Subhadrabandhu T. The relationship of pes planus and calcaneal spur to plantar heel pain. Clin Orthop Relat Res,1994,(306):192-196.
15 Buck FM, Hoffmann A, Mamisch-Saupe N, et al. Hindfoot alignment measurements:rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. AJR Am J Roentgenol, 2011,197(3):578-582.
16 Chi TD, Toolan BC, Sangeorzan BJ, et al. The lateral column lengthening and medial column stabilization procedures. Clin Orthop Relat Res, 1999,(365):81-90.
17 Lu CK, Fu YC, Cheng YM, et al. Isolated talonavicular arthrodesis for Miiller-Weiss disease. Kaohsiung J Med Sci, 2014, 30(9):471-476.
18 Avila A, Li S, Myerson M, et al. The use of isolated calcaneus osteotomy in the treatment of Muller Weiss disease. Foot Ankle Surg, 2016, 22(2):83.
19 Li SY, Myerson MS, Monteagudo M, et al. Efficacy of calcaneus osteotomy for treatment of symptomatic Miiller-Weiss disease.Foot Ankle Int, 2017, 38(3):261-269.
2 Mohiuddin T, Jennison T, Damany D. Muller-Weiss diseaseReview of current knowledge. Foot Ankle Surg, 2014, 20(2):79-84.
3 Samim M,Moukaddam HA,Smitaman E. Imaging of MuellerWeiss syndrome:A review of clinical presentations and imaging spectrum. AJR Am J Roentgenol, 2016, 207(2):W8-W18.
4胡东,张言,梁晓军,等.单纯距舟关节融合术治疗Muller-Weiss病疗效分析.中国修复重建外科杂志,2017, 31(12):1434-1437.
5 Cao HH, Lu WZ, Tang KL. Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Miiller-Weiss disease. J Orthop Surg Res, 2017,12(1):83.
6 Lui TH. Arthroscopic triple arthrodesis in patients with Muller Weiss disease. Foot Ankle Surg, 2009, 15(3):119-122.
7 Janositz G, Sisak K, Toth K. Percutaneous decompression for the treatment of Mueller-Weiss syndrome. Knee Surg Sports Traumatol Arthrosc, 2011,19(4):688-690.
8 Tosun B, AI F, Tosun A. Spontaneous osteonecrosis of the tarsalnavicular in an adult:Mueller-Weiss syndrome. J Foot Ankle Surg,2011, 50(2):221-224.
9 Maceira E,Rochera R. Miiller-Weiss disease:clinical and biomechanical features. Foot Ankle Clin, 2004, 9(1):105-125.
10 Turner NM, van de Leemput AJ, Draaisma JM, et al. Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills. Med Educ, 2008, 42(5):503-511.
11 Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994,15(7):349-353.
12 Doyle T, Napier RJ, Wong-Chung J. Recognition and management of Muller-Weiss disease. Foot Ankle Int, 2012, 33(4):275-281.
13 Huson A. Biomechanics of the tarsal mechanism. A key to the function of the normal human foot. J Am Podiatr Med Assoc,2000, 90(1):12-17.
14 Prichasuk S, Subhadrabandhu T. The relationship of pes planus and calcaneal spur to plantar heel pain. Clin Orthop Relat Res,1994,(306):192-196.
15 Buck FM, Hoffmann A, Mamisch-Saupe N, et al. Hindfoot alignment measurements:rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. AJR Am J Roentgenol, 2011,197(3):578-582.
16 Chi TD, Toolan BC, Sangeorzan BJ, et al. The lateral column lengthening and medial column stabilization procedures. Clin Orthop Relat Res, 1999,(365):81-90.
17 Lu CK, Fu YC, Cheng YM, et al. Isolated talonavicular arthrodesis for Miiller-Weiss disease. Kaohsiung J Med Sci, 2014, 30(9):471-476.
18 Avila A, Li S, Myerson M, et al. The use of isolated calcaneus osteotomy in the treatment of Muller Weiss disease. Foot Ankle Surg, 2016, 22(2):83.
19 Li SY, Myerson MS, Monteagudo M, et al. Efficacy of calcaneus osteotomy for treatment of symptomatic Miiller-Weiss disease.Foot Ankle Int, 2017, 38(3):261-269.
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