足根骨癒合症の観血的治療

Surgical Treatment of Tarsal Coalition

　癒合部切除による関節形成術で自・他覚的に症状改善をみた距・踵骨癒合症2例，踵・舟状骨癒合症の1例について報告した．距・踵骨癒合症に対する癒合部切除術は従来行われてきた3関節固定術に比べて低侵襲で，除痛に加え関節機能の獲得が見込める，より望ましい術式である．術前にCT像で癒合部の範囲を評価したうえで選択すべきである．踵・舟状骨癒合症の1例は癒合部切除術の結果できた空隙に外側果上皮弁による血管茎付き脂肪弁を充填した．本方法は血腫貯留と分離部の再癒合を効果的に予防でき，有用な方法であると考えている．

　Three cases of symptomatic tarsal coalition are reported. A talocalcaneal bridge was resected in one patient with unilateral talocalcaneal coalition and in the right foot of one patient with bilateral talocalcaneal coalition. The range of ankle inversion improved in the former case but not in the latter. The involved surface of the subtalar joint was 33％ and 45％ of the total surface, respectively, as seen using coronal computed tomography. A calcaneonavicular bar was resected in the patient with unilateral calcaneonavicular coalition, and the dead space was filled with a lateral supramalleolar adipofascial flap. The range of inversion and eversion increased to that seen on the uninvolved side several months postoperatively. The lateral supramalleolar adipofascial flap seems to be most suitable for preventing re-union after mobilization of calcaneonavicular coalition, because it has vascularity and is volumious enough to obliterate a large dead space created by resection of the calcaneonavicular bar.