횡족근 관절의 단일 및 이중 유합술의 비교

Comparison of Single and Double Fusions in Transverse Tarsal Joint

  • 윤현국 (연세대학교 의과대학 정형외과학교실) ;
  • 이종석 (연세대학교 의과대학 정형외과학교실) ;
  • 이진우 (연세대학교 의과대학 정형외과학교실)
  • Youn, Hyun-Kook (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Lee, Jong-Seok (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Lee, Jin-Woo (Department of Orthopaedic Surgery, Yonsei University College of Medicine)
  • 투고 : 2011.01.21
  • 심사 : 2011.02.22
  • 발행 : 2011.03.15

초록

Purpose: The purpose of this study was to compare the clinical and radiological results of single and double fusions in the transverse tarsal joint. Materials and Methods: Between December 2000 and April 2009, 16 patients (16 feet) who had been treated by fusion of transverse tarsal joint were included in this study. In 8 patients, only talonavicular joint was fused and in the other 8 patients, both talonavicular and calcaneocuboid joints were fused simultaneously. We have measured talo-first metatarsal angle, calcaneal pitch angle, talonavicular coverage angle and presence of adjacent joint arthritis for radiological assessment at both preoperative and last visit. Furthermore, we have evaluated Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction. Results: In a single fusion group, VAS was improved from $6.4{\pm}1.4$ to $0.8{\pm}1.0$ (p=0.0011) and AOFAS score was improved from $63.8{\pm}6.2$ to $89.4{\pm}9.8$ (p=0.0012). In a double fusion group, VAS was improved from $8.0{\pm}0.75$ to $2.0{\pm}1.8$ (p=0.0011) and AOFAS score was improved from $60.5{\pm}11.2$ to $89.5{\pm}6.0$ (p=0.0012). In the difference of talo-first metatarsal angle between two groups, a single fused group was more improved than a double fused group (p=0.04). Conclusion: Both single and double fusions are useful and attractive treatment for the transverse tarsal joint arthritis. Furthermore, a single fusion has advantages of less invasiveness and preserving some degree of hindfoot motion and could be an effective alternative to a double fusion if patient meets appropriate criteria through careful preoperative evaluation.

키워드

참고문헌

  1. Sammarco VJ. The talonavicular and calcaneocuboid joints: Anatomy, biomechanics, and clinical management of the transverse tarsal joint. Foot Ankle Clin. 2004;9:127-45. https://doi.org/10.1016/S1083-7515(03)00152-9
  2. Coetzee JC, Castro MD. The indications and biomechanical rationale for various hindfoot procedures in the treatment of posterior tibialis tendon dysfunction. Foot Ankle Clin. 2003; 8:453-9. https://doi.org/10.1016/S1083-7515(03)00038-X
  3. Francisco R, Chiodo CP, Wilson MG. Management of the rigid adult acquired flatfoot deformity. Foot Ankle Clin. 2007; 12:317-27. https://doi.org/10.1016/j.fcl.2007.03.013
  4. Mann RA, Beaman DN. Double arthrodesis in the adult. Clin Orthop Relat Res. 1999;74-80.
  5. O'Malley MJ, Deland JT, Lee KT. Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity: An in vitro study. Foot Ankle Int. 1995;16:411-7. https://doi.org/10.1177/107110079501600706
  6. Suckel A, Muller O, Herberts T, Langenstein P, Reize P, Wulker N. Talonavicular arthrodesis or triple arthrodesis: Peak pressure in the adjacent joints measured in 8 cadaver specimens. Acta Orthop. 2007;78:592-7. https://doi.org/10.1080/17453670710014275
  7. Clain MR, Baxter DE. Simultaneous calcaneocuboid and talonavicular fusion. Long-term follow-up study. J Bone Joint Surg Br. 1994;76:133-6.
  8. Thelen S, Rütt J, Wild M, Lögters T, Windolf J, Koebke J. The influence of talonavicular versus double arthrodesis on load dependent motion of the midtarsal joint. Arch Orthop Trauma Surg. 2010;130:47-53. https://doi.org/10.1007/s00402-009-0878-9
  9. Wapner KL. Triple arthrodesis in adults. J Am Acad Orthop Surg. 1998;6:188-96. https://doi.org/10.5435/00124635-199805000-00007
  10. Deland JT, Otis JC, Lee KT, Kenneally SM. Lateral column lengthening with calcaneocuboid fusion: Range of motion in the triple joint complex. Foot Ankle Int. 1995;16:729-33. https://doi.org/10.1177/107110079501601111
  11. Astion DJ, Deland JT, Otis JC, Kenneally S. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am. 1997;79:241-6. https://doi.org/10.2106/00004623-199702000-00012
  12. Wülker N, Stukenborg C, Savory KM, Alfke D. Hindfoot motion after isolated and combined arthrodeses: Measurements in anatomic specimens. Foot Ankle Int. 2000;21:921-7. https://doi.org/10.1177/107110070002101106
  13. Tanaka Y, Takakura Y, Taniguchi A, Sugimoto K, Kumai T, Fukui A. Partial tarsal arthrodesis for rheumatoid feet. Mod Rheumatol. 2004;14:130-4. https://doi.org/10.3109/s10165-004-0279-4
  14. Fernandez de Retana P, Maceira E, Fernandez-Valencia JA, Suso S. Arthrodesis of the talonavicular-cuneiform joints in Müller-Weiss disease. Foot Ankle Clin. 2004;9:65-72. https://doi.org/10.1016/S1083-7515(03)00175-X
  15. Chen CH, Huang PJ, Chen TB, et al. Isolated talonavicular arthrodesis for talonavicular arthritis. Foot Ankle Int. 2001; 22:633-6. https://doi.org/10.1177/107110070102200803
  16. Chiodo CP, Martin T, Wilson MG. A technique for isolated arthrodesis for inflammatory arthritis of the talonavicular joint. Foot Ankle Int. 2000;21:307-10. https://doi.org/10.1177/107110070002100406
  17. Fogel GR, Katoh Y, Rand JA, Chao EY. Talonavicular arthrodesis for isolated arthrosis: 9.5-year results and gait analysis. Foot Ankle. 1982;3:105-13. https://doi.org/10.1177/107110078200300210
  18. Fortin PT. Posterior tibial tendon insufficiency: Isolated fusion of the talonavicular joint. Foot Ankle Clin. 2001;6:137-51. https://doi.org/10.1016/S1083-7515(03)00087-1
  19. Yu GV, Shook JE. Rearfoot arthrodesis. Part 2: Selected arthrodesis. In: Banks AS, Downey MS, Martin DE, Miller SJ, ed. McGlamry's comprehensive textbook of foot and ankle surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. 1193-218.
  20. Weinheimer D. Talonavicular arthrodesis. Clin Podiatr Med Surg. 2004;21:227-40. https://doi.org/10.1016/j.cpm.2004.01.003