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首页> 外文期刊>Foot and ankle international >Lateral column calcaneal lengthening, flexor digitorum longus transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study.
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Lateral column calcaneal lengthening, flexor digitorum longus transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study.

机译：跟骨外侧跟骨加长，趾长屈肌屈肌转移和楔形楔形楔形内切开术用于柔性扁平足：一项生物力学研究。

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BACKGROUND: Lengthening of the lateral column is commonly used for reconstruction of the adult and pediatric flatfoot, but can result in supination of the foot and symptomatic lateral column overload. The addition of a medial cuneiform osteotomy has been used to redistribute forces to the medial column. The combined use of a lateral column lengthening and medial cuneiform osteotomy in a reproducible cadaver flatfoot model was evaluated. METHODS: Twelve cadaver specimens were physiologically loaded and each was evaluated radiographically and pedobarographically in the following conditions: 1) intact, 2) severe flatfoot, 3) lateral column lengthening with simulated flexor digitorum longus transfer, and 4) lateral column lengthening and flexor digitorum longus (FDL) transfer with added medial cuneiform osteotomy. The lateral column lengthening was performed with a 10-mm foam bone wedge through the anterior process of the calcaneus, and the medial cuneiform osteotomy was performed with a dorsally placed 6-mm wedge. RESULTS: Lateral column lengthening with simulated FDL transfer on a severe flatfoot model resulted in a significant change as compared with the flatfoot deformity in three measurements: in lateral talus-first metatarsal angle (-17 to -7 degrees; p<0.001), talonavicular angle (46 to 24 degrees; p<0.001), and medial cuneiform height (16 to 20 mm; p<0.001). Lateral forefoot pressure increased from 24.6 to 33.9 kPa (p<0.001) after these corrections as compared with the flatfoot. Adding a medial cuneiform osteotomy decreased the lateral talar-first metatarsal angle from -7 to -4 degrees, decreased the talonavicular coverage angle from 24 to 20 degrees, and increased the medial cuneiform height from 20 to 25 mm. After added medial cuneiform osteotomy, lateral pressure was significantly different from that of the flatfoot (p=0.01) and was not significantly different from that of the intact foot (p=0.14). Medial forefoot pressure was overcorrected as compared with the intact foot with added medial cuneiform osteotomy. CONCLUSIONS: Lateral column lengthening increased lateral forefoot pressures in a severe flatfoot model. An added medial cuneiform osteotomy provided increased deformity correction and decreased pressure under the lateral forefoot.
机译：背景：外侧柱的加长通常用于成人和小儿扁平足的重建，但是会导致脚后倾和有症状的外侧柱超负荷。内侧楔形截骨术已被用于将力重新分配至内侧柱。在可复制的尸体扁平足模型中，评估了外侧柱加长和内侧楔形截骨术的联合使用。方法：对十二具尸体标本进行生理加载，并在以下条件下进行射线照相和足部气压描记术评估：1）完整，2）严重扁平足，3）侧柱延长，模拟屈指趾屈伸转移，4）侧柱延长和屈指趾屈肌股骨远端截骨术（FDL）转移。通过跟骨前突用10 mm泡沫骨楔进行外侧柱加长，并使用6 mm背侧楔入进行楔形内截骨术。结果：在严重的扁平足模型上，通过模拟FDL转移进行侧柱加长，与扁平足畸形相比在以下三个方面的测量结果发生了显着变化：距骨距第一first骨角（-17至-7度; p <0.001），距眼角（46至24度; p <0.001）和楔形内侧骨高度（16至20 mm; p <0.001）。与平足相比，这些校正后，前足外侧压力从24.6 kPa增加到33.9 kPa（p <0.001）。添加内侧楔形骨截骨术可将外侧距骨第一first骨角从-7度降低至-4度，将距骨眼覆盖角从24度降低至20度，并将内侧楔形骨高度从20 mm增至25 mm。添加内侧楔形截骨后，侧压与扁平足的侧压显着不同（p = 0.01），与完整脚的侧压无显着差异（p = 0.14）。与完整的脚相比，内侧前脚的压力被过度矫正，增加了楔形楔形截骨术。结论：在严重的扁平足模型中，外侧柱长的增加会增加外侧前脚的压力。增加的内侧楔形截骨术增加了畸形矫正，并降低了前足外侧下的压力。

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