改良Zadek截骨治疗跟骨Haglund综合征

Modified Zadek osteotomy for the treatment of Haglund syndrome

摘要:

[目的]介绍改良 Zadek 背侧闭合楔形跟骨截骨术治疗 Haglund 综合征的手术技术和初步临床效果。[方法]2019 年 5 月—2021 年 8 月应用改良背侧闭合楔形跟骨截骨术治疗 Haglund 综合征 12 例。患者取健侧卧位，行跟腱前外侧纵行切口， 暴露跟腱止点以清除病变滑囊组织，并根据术前设计进行跟骨后上结节截骨及跟骨体楔形截骨。截骨后闭合楔形截骨区域，使跟腱止点向前上方旋转位移，矫正畸形。[结果]12 例患者均顺利完成手术，无严重并发症。随访时间 9~24 个月。与术前相比，末次随访时，VAS 评分，AOFAS 踝-后足部评分及影像测量跟骨 FPA 角度均显著改善（P＜0.05），根据 Arner-Lindholm 评分，优 10 例，良 2 例，优良率为 100%（12/12）。[结论]采用改良术式治疗 Haglund 综合征，可有效缓解足跟疼痛，矫正跟骨结节后突畸形以及恢复踝关节功能。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical effect of modified Zadek dorsal closed wedge calca-neus osteotomy for Haglund syndrome.[Methods] From May 2019 to August 2021, 12 patients received modified dorsal closed wedge calca-neal osteotomy for Haglund syndrome.The patient was placed in the healthy side lateral position, a longitudinal incision on the anterolateralside of the Achilles tendon was made to expose the insertion of the Achilles tendon.After debridement of pathology bursa, osteotomies wereconducted beginning from posterior superior calcaneal tubercle and wedging into the calcaneal body according to the preoperative design.Subsequently, the wedge- shaped bone block was removed, the wedge was closed by rotating and displacing the Achilles tendon insertionbone fragment forward and upward to correct the deformity.[Results] All the 12 patients had operation completed successfully without seri-ous complications, and followed up for 9~24 months.Compared with those before operation, the VAS score, AOFAS ankle and hindfoot scoreand Fowler-Philip angle measured on images were significantly improved at the last follow-up (P＜0.05).According to Arner Lindholm crite-ria, 10 cases were excellent, 2 cases were good, with the excellent and good rate of 100% (12/12).[Conclusion] This modified Zadek dorsalclosed wedge calcaneus osteotomy for Haglund syndrome does effectively relieve heel pain, correct calcaneal tubercle retrogression deformi-ty to restore ankle function.