成人获得性扁平足资料.ppt

Conical Subtalar Implant (CSI) Maxwell-Brancheau arthroereisis (MBA) 手术治疗 3期： 距下关节融合 双关节融合术 三关节融合术 4期: 后足畸形固定+距骨倾斜+无症状的踝关节炎→三关节融合 后足畸形固定+距骨倾斜+症状性的踝关节炎→后足融合+踝关节置换术 踝关节置换术的禁忌征 三角韧带严重松弛 三关节融合后畸形进展 手术治疗 谢谢! * Bluman EM;Posterior tibial tendon rupture: a refined classification system.;Foot Ankle Clin.2007V12N2:233-249 * The STA-Peg implant is an example of an impact-blocking device or direct impact implant. Without changing the subtalar joint axis, these implants limit anterior displacement of the lateral talar process. An axis-altering device actually elevates the floor of the sinus tarsi and accordingly elevates the subtalar joint axis, reducing calcaneal eversion. In the late 1970s, Smith developed the polyethylene disk and peg implant (STA-Peg, Wright Medical) and placed the stem of these implants vertically in the floor of the calcaneus.   * ?Lundeen modified the STA-Peg by applying an inclined platform initially and subsequently created five different sizes known as the Lundeen Subtalar Implant (LSI, Sgarlato Labs).17 The disk elevates the floor of the sinus tarsi, altering the STJ axis. This will not be as effective as other techniques in correcting the transverse planar dominant foot type. The technique also requires the articular surface of the talar posterior facet to ride up on the implant surface. This makes the joint subject to more wear and tear. With this technique, it is also more difficult to limit the precise amount of pronation.  * The Conical Subtalar Implant features a progressive softening of the threads and holes that allow for soft tissue ingrowth.  成人获得性平足症的治疗 平足症分型 先天性 获得性 青少年 成人 柔性 僵硬性 定 义 指有症状的成年人继发性扁平足 病因 退变 创伤 糖尿病 类风湿性关节炎 神经性病变 肿瘤 胫后肌腱功能不全 （Posterior tibial tendon dysfunction，PTTD） PTTD分期 (Johnson, Strom) 1期： 内踝下方疼痛及轻度肿胀 局部压痛 后足力线正常，多趾征阴性 关节活动正常，单足提踵力稍减弱 病理：肌腱深面可有一或几个纵形撕裂。也可只有腱鞘滑膜炎或肌腱增粗 PTTD分期(Johnson,Strom) 2期： 内踝部疼痛肿胀持续数月或数年 疼痛及肿胀更加明显 多趾征阳性 后足活动度正常，但足负重后呈外翻位 单足提踵力明显减弱 病理：肌腱延长增粗。可见有数