• 第三軍醫(yī)大學西南醫(yī)院骨科 全軍矯形外科中心（重慶，400038）# 現在重慶市中醫(yī)院（重慶市第一人民醫(yī)院）骨科;

目的 探討副舟骨切除結合脛后肌腱止點前置重建治療副舟骨源性平足癥的方法及臨床療效。 方法 2006 年5 月－ 2011 年6 月，收治33 例（40 足）經6 個月以上保守治療無效的副舟骨源性平足癥患者。男14 例（17足）， 女 19 例（23 足）；年齡16 ～ 56 歲，平均30.1 歲。均有雙側副舟骨，其中單側發(fā)病26 例，雙側7 例。出現平足癥狀至入院時間為7 個月～ 9 年，中位時間24 個月。中足功能采用美國矯形足踝協會（AOFAS）評分標準評定為（47.9 ± 7.3）分。X 線片檢查示，均有足部Ⅱ型副舟骨，足弓高度不同程度丟失，均伴后足輕度畸形。術中切除副舟骨，行脛后肌腱止點前置帶線錨釘重建術治療。 結果 術后患者切口均Ⅰ期愈合，無相關并發(fā)癥發(fā)生。術后30 例（36 足）患者獲隨訪，隨訪時間6 ～ 54 個月，平均23 個月。患者術后6 個月足部疼痛均消失，足部外觀明顯改善。末次隨訪時中足功能AOFAS 評分為（90.4 ± 2.0）分，與術前比較差異有統計學意義（t=29.73，P=0.00）。X 線片檢查，均無內固定錨釘松動、斷裂等發(fā)生；足弓高度、跟骨傾斜角、跟距角及距骨- 第1 跖骨角與術前比較，差異均有統計學意義（P  lt; 0.01）。 結論 采用副舟骨切除結合脛后肌腱止點前置重建治療副舟骨源性平足癥可有效糾正平足畸形，足功能恢復好，并發(fā)癥少。

引用本文： 曹洪輝,唐康來,鄧銀栓,譚曉康,周兵華,陶旭,陳磊,陳前博. 副舟骨切除結合脛后肌腱止點前置重建治療副舟骨源性平足癥. 中國修復重建外科雜志, 2012, 26(6): 686-690. doi: 復制

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1. 王正義, 唐康來. 重視成年人平足癥的診斷與治療. 中華醫(yī)學雜志, 2010, 90(33): 2305-2307.
2. Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
3. Kiter E, Erdag N, Karatosun V, et al. Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot. Acta Orthop Scand, 1999, 70(6): 618-621.
4. Bernaerts A, Vanhoenacker FM, Van de Perre S, et al. Accessory navicular bone: not such a normal variant. JBR-BTR, 2004, 87(5): 250-252.
5. Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop Relat Res, 1979, (144): 233-237.
6. Kanatli U, Yetkin H, Yalcin N. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system. Foot Ankle Int, 2003, 24(6): 486-489.
7. 唐康來, 周建波, 楊會峰, 等. 三關節(jié)截骨矯形融合治療ⅡB和Ⅲ期成年人獲得性平足癥. 中華醫(yī)學雜志, 2010, 90(33): 2313-2316.
8. Macnicol MF, Voutsinas S. Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg (Br), 1984, 66(2): 218-226.
9. Bennett GL, Weiner DS, Leighley B. Surgical treatment of symptomatic accessory tarsal navicular. Pediatr Orthop, 1990, 10(4): 445-449.
10. Kopp FJ, Marcus RE. Clinical outcome of surgical treatment of the symptomatic accessory navicular. Foot Ankle Int, 2004, 25(1): 27-30.
11. Senses I, Kiter E, Gunal I. Restoring the continuity of the tibialis posterior tendon in the treatment of symptomatic accessory navicular with flat feet. J Orthop Sci, 2004, 9(4): 408-409.
12. Swords MP, Shank JR, Hansen ST Jr, et al. Fusion of the primary and accessory navicular bones: a modification of the kidner procedure. Operative Techniques in Orthopaedics, 2004, 14 (1): 31-35.
13. Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
14. Dawson DM, Julsrud ME, Erdmann BB, et al. Modified Kidner procedure utilizing a Mitek bone anchor. J Foot Ankle Surg, 1998, 37(2): 115-121.
15. Kiter E, Günal I, Turgut A, et al. Evaluation of simple excision in the treatment of symptomatic accessory navicular associated with flat feet. J Orthop Sci, 2000, 5(4): 333-335.
16. Jasiewicz B, Potaczek T, Kacki W, et al. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones. Foot Ankle Surg, 2008, 14(2): 57-61.
17. Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Techniques in Foot and Ankle Surgery, 2007, 6(3): 195-200.
18. Knupp M, Hintermann B. Reconstruction in posttraumatic combined avulsion of an accessory navicular and the posterior tibial tendon. Techniques in Foot and Ankle Surgery, 2005, 4(2): 113-118.
  1. 1. 王正義, 唐康來. 重視成年人平足癥的診斷與治療. 中華醫(yī)學雜志, 2010, 90(33): 2305-2307.
  2. 2. Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
  3. 3. Kiter E, Erdag N, Karatosun V, et al. Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot. Acta Orthop Scand, 1999, 70(6): 618-621.
  4. 4. Bernaerts A, Vanhoenacker FM, Van de Perre S, et al. Accessory navicular bone: not such a normal variant. JBR-BTR, 2004, 87(5): 250-252.
  5. 5. Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop Relat Res, 1979, (144): 233-237.
  6. 6. Kanatli U, Yetkin H, Yalcin N. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system. Foot Ankle Int, 2003, 24(6): 486-489.
  7. 7. 唐康來, 周建波, 楊會峰, 等. 三關節(jié)截骨矯形融合治療ⅡB和Ⅲ期成年人獲得性平足癥. 中華醫(yī)學雜志, 2010, 90(33): 2313-2316.
  8. 8. Macnicol MF, Voutsinas S. Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg (Br), 1984, 66(2): 218-226.
  9. 9. Bennett GL, Weiner DS, Leighley B. Surgical treatment of symptomatic accessory tarsal navicular. Pediatr Orthop, 1990, 10(4): 445-449.
  10. 10. Kopp FJ, Marcus RE. Clinical outcome of surgical treatment of the symptomatic accessory navicular. Foot Ankle Int, 2004, 25(1): 27-30.
  11. 11. Senses I, Kiter E, Gunal I. Restoring the continuity of the tibialis posterior tendon in the treatment of symptomatic accessory navicular with flat feet. J Orthop Sci, 2004, 9(4): 408-409.
  12. 12. Swords MP, Shank JR, Hansen ST Jr, et al. Fusion of the primary and accessory navicular bones: a modification of the kidner procedure. Operative Techniques in Orthopaedics, 2004, 14 (1): 31-35.
  13. 13. Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
  14. 14. Dawson DM, Julsrud ME, Erdmann BB, et al. Modified Kidner procedure utilizing a Mitek bone anchor. J Foot Ankle Surg, 1998, 37(2): 115-121.
  15. 15. Kiter E, Günal I, Turgut A, et al. Evaluation of simple excision in the treatment of symptomatic accessory navicular associated with flat feet. J Orthop Sci, 2000, 5(4): 333-335.
  16. 16. Jasiewicz B, Potaczek T, Kacki W, et al. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones. Foot Ankle Surg, 2008, 14(2): 57-61.
  17. 17. Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Techniques in Foot and Ankle Surgery, 2007, 6(3): 195-200.
  18. 18. Knupp M, Hintermann B. Reconstruction in posttraumatic combined avulsion of an accessory navicular and the posterior tibial tendon. Techniques in Foot and Ankle Surgery, 2005, 4(2): 113-118.