改良式胫骨后肌腱重建术治疗Ⅱ型痛性副舟骨的临床效果及安全性OA
Clinical efficacy and safety of modified tibialis posterior tendon reconstruction in the treatment of type Ⅱ painful accessory navicular bone
目的 探讨改良式胫骨后肌腱重建术治疗Ⅱ型痛性副舟骨的临床效果及手术安全性.方法 回顾性纳入2021年8月至2023年8月收治的Ⅱ型痛性副舟骨患者61例,根据患者所采用的术式,将其分成A、B两组,A组采用改良式胫骨后肌腱重建术(副舟骨切除、带缝线金属骨锚钉胫骨后肌腱重建术)治疗,B组采用Kidner手术治疗.比较两组术前与随访结束时美国骨科足踝协会(AOFAS)中足量表、疼痛视觉模拟评分法(VAS)评分以及影像学测量指标,比较术后3 d血清炎症指标及术后完全负重时间,并观察并发症发生情况.结果 所有患者术后随访时间为12.1～18.8(15.6±3.1)个月,无失访患者.随访结束时,两组疼痛VAS评分低于术前,AOFAS中足量表评分高于术前,跟骨倾斜角、距骨外侧角、距骨-第一跖骨角度、距骨前后第一跖骨角以及距舟覆盖角均较术前有所改善(P<0.05).术前及随访结束时,两组疼痛VAS、AOFAS中足量表评分及影像学测量指标比较无统计学差异(P>0.05).术后3 d,两组血清C反应蛋白、白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α水平比较无统计学差异(P>0.05).A组术后完全负重时间为(12.00±1.00)周,较B组的(13.00±1.64)周缩短(P<0.05).两组均未出现神经、血管损伤,除B组1例术后第7天出现切口感染外,其余切口均顺利愈合.结论 改良式胫骨后肌腱重建术与传统Kidner手术治疗Ⅱ型痛性副舟骨,均能缓解患者疼痛症状、改善患足功能,且表现出较高的手术安全性,但前者完全负重时间较后者更短,具有一定优越性.
Objective To investigate the clinical efficacy and surgical safety of modified tibialis posterior tendon reconstruction in the treatment of type Ⅱ painful accessory navicular bone.Methods A total of 61 patients with type Ⅱ painful accessory navicular bone who were admitted from August 2021 to August 2023 were retrospectively included.According to the surgical methods adopted by the patients,they were divided into two groups,Group A and Group B.Group A was treated with modified tibialis posterior tendon reconstruction(excision of the accessory navicular bone and reconstruction of the posterior tibial tendon with suture anchors),while Group B underwent Kidner surgery.The preoperative and final follow-up scores of the American Orthopedic Foot and Ankle Society(AOFAS)midfoot scale,the Visual Analogue Scale(VAS)pain score,and radiographic parameters were compared between the two groups.The serum inflammatory indicators at 3 d after surgery and the time to complete weight-bearing after surgery were also compared,and the occurrence of complications was observed.Results The postoperative follow-up period for all patients ranged from 12.1 to 18.8(15.6±3.1)months,with no patients lost to follow-up.At the end of the follow-up,the VAS pain scores of both groups were lower than those before surgery,and the AOFAS midfoot scale score was higher than that before surgery.The calcaneal pitch angle,talar tilt angle,talo-first metatarsal angle,anteriorposterior talo-first metatarsal angle,and talonavicular coverage angle all improved compared with those before the surgery(P<0.05).Before the surgery and at the end of the follow-up,there was no significant difference in VAS pain score,AOFAS midfoot scale score,and radiographic parameters between the two groups(P>0.05).At 3 d after the surgery,there was no significant difference in serum C-reactive protein,interleukin-1β,interleukin-6,and tumor necrosis factor-α levels between the two groups(P>0.05).The postoperative complete weight-bearing time of group A was(12.00±1.00)weeks,which was shorter than that of group B[(13.00±1.64)weeks](P<0.05).Neither group had nerve or vascular injuries.Except for one case in group B that developed incision infection on the 7th day after the surgery,all incisions healed smoothly.Conclusion The modified tibialis posterior tendon reconstruction,as well as the traditional Kidner surgery for treating type Ⅱ painful accessory navicular bones,can all alleviate the pain symptoms of patients and improve the function of the affected foot,showing high surgical safety.However,the complete weight-bearing time of the former is shorter than that of the latter,and it has certain advantages.
张亚兴;刘斌;王艳涛;蒲晓鹏;康强军
解放军联勤保障部队第九八〇医院骨科,石家庄 050082解放军联勤保障部队第九八〇医院骨科,石家庄 050082解放军联勤保障部队第九八〇医院骨科,石家庄 050082解放军联勤保障部队第九八〇医院骨科,石家庄 050082解放军联勤保障部队第九八〇医院骨科,石家庄 050082
Ⅱ型痛性副舟骨胫骨后肌腱肌腱重建疼痛安全性足功能
type Ⅱ painful accessory navicular boneposterior tibial tendontendon reconstructionpainsafetyfoot function
《临床误诊误治》 2026 (3)
46-52,7
2026年度河北省医学科学研究课题计划项目(20261426)
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