[1]王勇,张宇,张文举,等.距舟-舟楔关节融合联合自体髂骨植骨治疗MaceiraⅣ、Ⅴ期Müller-Weiss病[J].中医正骨,2022,34(01):73-77.
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距舟-舟楔关节融合联合自体髂骨植骨治疗MaceiraⅣ、Ⅴ期Müller-Weiss病()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年01期
页码:
73-77
栏目:
临床报道
出版日期:
2022-01-20

文章信息/Info

作者:
王勇; 张宇; 张文举; 徐善强; 李平; 何凯元
(四川省骨科医院,四川 成都 610041)
关键词:
骨坏死;  跗骨;  关节融合术;  骨移植;  Müller-Weiss病
摘要:
目的:观察距舟-舟楔关节融合联合自体髂骨植骨治疗MaceiraⅣ、Ⅴ期Müller-Weiss病的临床疗效和安全性。方法:2017年1月至2020年1月,采用距舟-舟楔关节融合联合自体髂骨植骨治疗MaceiraⅣ、Ⅴ期Müller-Weiss病患者12例。男2例,女10例; 年龄48～70岁,中位数58岁; 单足8例,双足4例; MaceiraⅣ期9例,MaceiraⅤ期3例。所有患者均经非手术治疗后效果不佳。术前行足部CT三维重建及MRI检查均显示舟骨外侧完全压缩、硬化,距舟关节及舟楔关节均出现关节炎改变。病程2～12年,中位数5年。术后随访观察关节融合、足部畸形矫正、疼痛缓解、患足功能恢复及并发症发生情况。结果:所有患者均获随访,随访时间14～42个月,中位数23个月。距舟关节和舟楔关节均骨性融合,融合时间12～16周,中位数12周。距舟覆盖角,术前26.4°±2.1°、术后12个月6.1°±1.7°; 足正位X线片上距骨第1跖骨角,术前-11.5°±3.5°、术后12个月1.6°±2.1°; 足侧位X线片上距骨第1跖骨角,术前16.2°±4.5°、术后12个月5.3°±1.4°; 足部疼痛视觉模拟量表评分,术前(6.4±1.9)分、术后12个月(1.6±0.5)分; 美国足与踝关节协会中部足功能评分,术前(55.4±4.8)分、术后12个月(92.3±4.2)分。1例出现切口感染,行局部清创、植皮后创面愈合,其余患者切口均甲级愈合; 2例出现足背麻木等症状,口服甲钴胺2个月后症状缓解; 所有患者均未发生内固定松动及断裂。结论:采用距舟-舟楔关节融合联合自体髂骨植骨治疗MaceiraⅣ、Ⅴ期Müller-Weiss病,能矫正足部畸形、缓解足部疼痛、促进足部功能的恢复,且关节融合率较高、并发症较少。

参考文献/References:

[1] HALLER J,SARTORIS D J,RESNICK D,et al.Spontaneous osteonecrosis of the tarsal navicular in adults:imaging findings[J].AJR Am J Roentgenol,1988,151(2):355-358.
[2] KITAURA Y,NISHIMURA A,NAKAZORA S,et al.Spontaneous osteonecrosis of the tarsal navicular:a report of two cases[J].Case Rep Orthop,2019,30:5952435.
[3] DOYLE T,NAPIER R J,WONG-CHUNG J.Recognition and management of Müller Weiss disease[J].Foot Ankle Int,2012,33(4):275-281.
[4] MACEIRA E,ROCHERA R.Müller-Weiss disease:clinical and biomechanical features[J].Foot Ankle Clin,2004,9(1):105-125.
[5] AHMED A A,KANDIL M I,TABL E A,et al.Müller-Weiss disease:a topical review[J].Foot Ankle Int,2019,40(12):1447-1457.
[6] RUIZ-ESCOBAR J,VILADOT-PERICé R,áLVAREZ-GOENAGA F,et al.Treatment with plantar supports in Müller-Weiss disease.Preliminary report[J].Acta Ortop Mex,2020,34(2):112-118.
[7] HARNROONGROJ T,THARMVIBOONSRI T,CHUCKPAIWONG B.Müller-Weiss disease:the descriptive factors of failure conservative treatment[J].Foot Ankle Int,2021,42(8):1022-1030.
[8] HARNROONGROJ T,CHUCKPAIWONG B.Müller-Weiss disease:three- to eight-year follow-up outcomes of isolated talonavicular arthrodesis[J].J Foot Ankle Surg,2018,57(5):1014-1019.
[9] MONTEAGUDO M,MACEIRA E.Management of Müller-Weiss disease[J].Foot Ankle Clin,2019,24(1):89-105.
[10] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:233-234.
[11] VAISHYA R,KUMAR V,AGARWAL A K,et a1.Spontaneous osteonecrosis of navicular and talus(SONND)[J].J Clin Orthop Trauma,2016,7(Suppl 1):83-87.
[12] HETSRONI I,NYSKA M,AYALON M.Plantar pressure distribution in patients with Müller-Weiss disease[J].Foot Ankle Int,2007,28(2):237-241.
[13] 袁承杰,王晨,耿翔,等.距骨去旋转并内侧柱融合治疗成人足舟骨坏死[J].中华骨科杂志,2019,39(9):572-578.
[14] PERISANO C,GRECO T,VITIELLO R,et al.Mueller-Weiss disease:review of the literature[J].J Biol Regul Homeost Agents,2018,32(6 Suppl 1):157-162.
[15] ANOSITZ G,SISáK K,TóTH K.Percutaneous decompression for the treatment of Mueller-Weiss syndrome[J].Knee Surg Sports Traumatol Arthrosc,2011,19(4):688-690.
[16] 屈福锋,蔡杰,梁晓军,等.距舟关节融合联合跟骨截骨治疗Müller-Weiss病的早期疗效[J].中国修复重建外科杂志,2019,33(2):166-169.
[17] LI S Y,MYERSON M S,MONTEAGUDO M,et al.Efficacy of calcaneus osteotomy for treatment of symptomatic Müller-Weiss disease[J].Foot Ankle Int,2017,38(3):261-269.
[18] ZHANG H,LI J,QIAO Y,et al.Open triple fusion versus TNC arthrodesis in the treatment of Mueller-Weiss disease[J].J Orthop Surg Res,2017,12(1):13.
[19] LUI T H.Arthroscopic triple arthrodesis in patients with Müller Weiss disease[J].Foot Ankle Surg,2009,15(3):119-122.
[20] VOLPE A,MONESTIER L,MALARA T,et al.Müller-Weiss disease:four case reports[J].World J Orthop,2020,11(11):507-515.
[21] MAYICH D J.The treatment of Mueller-Weiss disease:a systematic approach[J].Techniques in Foot & Ankle Surg,2016,15(2):59-73.
[22] FORNACIARI P,GILGEN A,ZWICKY L,et al.Isolated talonavicular fusion with tension band for Müller-Weiss syndrome[J].Foot Ankle Int,2014,35(12):1316-1322.
[23] WAUGH W.The ossification and vascularisation of the tarsal navicular and their relation to Kohler’s disease[J].J Bone Joint Surg Br,1958,40-B(4):765-777.

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备注/Memo

备注/Memo:
基金项目:四川省干部保健科研课题项目(川干研2021-606)
通讯作者:张宇 E-mail:zhangyudoc@126.com
更新日期/Last Update: 1900-01-01