手术切除跟舟骨桥后趾短伸肌转位和脂肪填塞的疗效对比

Efficacy analysis of extensor digitorum brevis transfer versus fat graft interposition following calcaneonavicular coalition resection

摘要:

目的探讨手术切除跟舟骨桥后，趾短伸肌转位和脂肪填塞治疗跟舟骨桥的疗效对比。 方法回顾性分析2008年7月—2018年8月上海交通大学医学院附属瑞金医院骨科手术治疗的跟舟骨桥患者28例的临床资料。其中男15例，女13例；年龄13~65岁，平均(33.5±4.8)岁。先天性骨桥13例，继发性骨桥15例。视觉模拟评分法(visual analogue scores, VAS)评分为4~8分，平均(5.5±0.5)分。美国足踝外科协会(America Orthopedic Foot and Ankle Society, AOFAS)足评分为44~76分，平均(62.6±1.2)分。根据患者接受的手术方式，自然分为两组: 趾短伸肌转位组(n=14)采用骨桥手术切除并趾短伸肌腱转位方法治疗；脂肪填塞组(n=14)采用骨桥切除并脂肪填塞法治疗。观察患者围手术期指标、影像学指标、VAS、AOFAS评分、有无复发等指标。 结果28例患者随访48~97个月，平均(65.5±7.3)个月，伤口均Ⅰ期愈合。末次随访时趾短伸肌转位组手术时间、住院时间长，伤口愈合时间短，VAS评分0~5分，平均(1.6±0.3)分。AOFAS后足评分78~100分，平均(88.6±1.4)分，无骨桥复发及关节退变发生。脂肪填塞组VAS评分0~4分，平均(1.9±0.2)分。AOFAS后足评分74~96分，平均(87.2±2.3)分，无骨桥复发及关节退变发生。脂肪填塞组术后1个月VAS评分较肌腱转位组低，差异有统计学意义。 结论手术切除跟舟骨桥并软组织植入可取得较好的疗效，趾短伸肌转位和脂肪填塞两种方法疗效相似。

Abstract:

ObjectiveTo compare the efficacy of extensor digitorum brevis transfer and fat graft interposition following surgical resection of calcaneonavicular coalition. MethodsA retrospective analysis was conducted on 28 patients with calcaneonavicular coalition who underwent surgical treatment in the Department of Orthopaedics at Rui Jin Hospital between July 2008 and August 2018. There were 15 males and 13 females with an average age of(33.5±4.8)(range: 13-65 years). There were 13 congenital calcaneonavicular coalitions and 15 acquired calcaneonavicular coalitions. Visual analogue scores of pain(VAS) was(5.5±0.5) points(range: 4-8 points). The mean America Orthopedic Foot and Ankle Society(AOFAS) midfoot score was(62.6±1.2) points(range: 44-76 points). The patients were divided into two groups based on the surgical procedure they received: one group(n=14) underwent surgical resection of the coalition combined with extensor digitorum brevis transfer, while the other group(n=14) received coalition resection with fat graft interposition. The perioperative parameters, imaging findings, VAS(visual analog scale) and AOFAS(American Orthopaedic Foot & Ankle Society) scores, and recurrence rates were evaluated in the two groups. ResultsAll the 28 patients were followed-up for a mean duration of(65±7.3) months(range: 48-97 months), with all surgical wounds healing primarily. At the final follow-up: the extensor digitorum brevis transfer group demonstrated longer operative time and hospital stay, and shorter wound healing time, the VAS scores ranged from 0 to 5 points [mean: (1.6±0.3) points], the AOFAS hindfoot scores ranged from 78 to 100 points [mean: (88.6±1.4) points]. The VAS scores in fat graft interposition group ranged from 0 to 4 points [mean: (1.9±0.2) points], the AOFAS hindfoot scores ranged from 74 to 96 points [mean: (87.2±2.3) points]. No coalition recurrence or joint degeneration were observed in all patients. Notably, the fat graft interposition group exhibited significantly lower VAS scores at 1-month post operation when compared to that in the tendon transfer group(P<0.05). ConclusionSurgical resection of calcaneonavicular coalition combined with soft tissue interposition yields satisfactory clinical outcomes. The efficacy of extensor digitorum brevis transfer and fat graft interposition is comparable in these patients.