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Title: [Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity].
Author: Shang L, Wang X, Wang A, Jia G, Li Q, Zhang X, Ma F, Wang Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Feb 15; 34(2):173-178. PubMed ID: 32030947.
Abstract:
OBJECTIVE: To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity. METHODS: Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation. RESULTS: All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores ( t=-23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones ( P<0.05), and the CP was significantly higher than preoperative one ( P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot). CONCLUSION: For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain. 目的: 探讨 Evans 跟骨外侧延长术治疗距跟联合合并后足外翻畸形的疗效。. 方法: 2014 年 1 月—2017 年 10 月，采取 Evans 跟骨外侧延长术治疗 10 例（13 足）距跟联合合并后足外翻畸形患者。男 6 例（8 足），女 4 例（5 足）；年龄 13～18 岁，平均 15.8 岁。病程 10～14 个月，平均 11.5 个月。患侧跟骨外翻、前足外展、足弓低平。疼痛部位：跗骨窦 4 足、距跟联合 5 足、踝关节 4 足。Silverskiold 试验腓肠肌腱膜紧张 3 例（4 足），跟腱挛缩 7 例（9 足）。术前美国矫形外科足踝协会（AOFAS）踝与后足评分为（46.54±9.08）分，行走 1 km 后疼痛视觉模拟评分（VAS）为（6.54±0.88）分。术后采用 AOFAS 踝与后足评分、VAS 评分，以及 X 线片测量距骨-第 1 跖列角（talar-first metatarsal angle，T1MT）、距舟覆盖角（talonavicular coverage angle，TCA）、距骨倾斜角（talar-horizontal angle，TH）、跟骨倾斜角（calcaneal pitch angle，CP）、跟骨外翻角（heel valgus angle，HV），评价手术疗效。. 结果: 术后切口均 Ⅰ 期愈合。10 例患者均获随访，随访时间 12～30 个月，平均 18 个月。末次随访时，AOFAS 踝与后足评分为（90.70±6.75）分，VAS 评分为（1.85±0.90）分，均较术前明显改善（ t=−23.380， P=0.000； t=35.218， P=0.000）。X 线片复查示截骨均达骨性愈合，愈合时间为 2～4 个月，平均 3 个月。末次随访时，T1MT、TCA、TH、HV 均较术前明显降低，CP 明显提高，差异有统计学意义（ P<0.05）。随访期间 1 例（1 足）疼痛缓解不明显，1 例（1 足）出现腓肠神经皮支损伤症状。. 结论: 对于距跟联合合并后足外翻畸形患者，Evans 跟骨外侧延长术可以有效纠正畸形、缓解疼痛。.

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