vol.34
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思春期扁平足に対し気孔率60％のβ-TCPを用いた踵骨骨切りによる外側支柱延長術を施行した1例
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Abstract
In foot and ankle surgery, we often use autogenous bone grafts from the iliac bone. However patients frequently complain of an iliac pain after surgery. To avoid this complication, we used β-TCP of the 60％ porosity for the lateral column lengthening by the calcaneal osteotomy in a patient with adolescent flatfoot.
The patient is an eighteen year-old male. He was indicated bilateral flat foot when he was a child. He has felt foot pain since high school student time. He was referred to our hospital, because he cannot play baseball to have pain. In the initial medical examination, he had tenderness along tibialis posterior tendon. Ankle range of motion and manual muscle testing was normal. The talo-first metatarsal angle was 12 degrees, the talocalcaneal angle was 39 degrees, and the calcaneal pitch angle was 9 degrees on weightbearing XP of right foot. We performed a lateral column lengthening by calcaneal osteotomy with β-TCP of the 60％ porosity for his flatfoot.
After surgery the talo-first metatarsal angle became from 12 to 6 degrees, the talocalcaneal angle became from 39 to 37 degrees, and the calcaneal pitch angle became from 9 to 11 degrees. He got bone union by 4 months. He went back to play baseball by 6 months. However he sprained left ankle after 2 years. Because he had felt left ankle pain, he requested surgical treatment as same as right ankle. After this surgery the talo-first metatarsal angle became from 15 to 10 degrees, the talocalcaneal angle became from 40 to 36 degrees, and the calcaneal pitch angle became from 8 to 8 degrees. He goes back to play baseball again.
In this case, foot in this patient was flexible flatfoot. Therefore we selected lateral column lengthening by the calcaneal osteotomy. We often use autogenous bone graft from the iliac bone in this procedure. Demerit of this procedure is anything there are cases when we cannot get to want size, volume and shape of bone graft and when patients remain an iliac pain. Recently because fixing material is improved, we discuss autogenous graft is substituted for artificial bone graft. Substitution rate of autogenous graft using β-TCP in young patients is higher than it in elder patients. Compressive strength in β-TCP of 60％ porosity is stronger than it in β-TCP of 75％ porosity. Therefore we consider we can use β-TCP of 60％ porosity in young patients, when we have to need a bone graft on foot and ankle surgery.
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