後脛骨筋腱機能不全・後期Stage 2に対する手術療法の成績―踵立方関節延長固定術と踵骨骨切り内側移動術の併用

Results of Treatment of Late Stage 2 Posterior Tibial Tendon Dysfunction by Combination of Calcaneocuboid Distraction Arthrodesis and Medial Displacement Calcaneal Osteotomy

　歩行困難な重度外反扁平足を呈した後脛骨筋腱機能不全・後期stage 2の4例4足(全例女性)に対して踵立方関節延長固定術(CCDA)と踵骨骨切り内側移動術(MDCO)を併用した手術療法を行った．年齢は平均63.3歳，経過観察期間は平均34.3カ月であった．手術前後の足部荷重位単純X線前後像および側面像からX線計測し，臨床評価には日本足の外科学会足部判定基準(JSSFスコア)を用いた．術後，各計測値は改善し，歩行困難であった患者全例が足底挿板を使用しているが，独歩可能となった．CCDAとMDCOを併用した手術療法は非常に有用な術式であった．

　The subjects ware 4 patients (4 feet：1 right, 3 left) with late stage 2 posterior tibial tendon dysfunction (PTTD).　All patients were women and were using a wheelchair at their first visit.　Their average age was 63.3 years, and the mean follow-up period was 34.3 months.　The operation consisted of calcaneocuboid distraction arthrodesis (CCDA) and medial displacement calcaneal osteotomy (MDCO).　The radiographic evaluation included weight-bearing AP and lateral views were used in the clinical evaluation.　All of the data had improved at follow-up.　All patients were able to walk unassisted at follow-up.　In treating severe flatfoot deformity caused by late stage 2 PTTD combination surgery consisting of CCDA and MDCO was very useful.