Objective To study the clinical effect of accessory navicular bone excision and posterior tibial tendon reconstruction combined with flexor digitorum longus tendon augmentation in the treatment of Ⅱ A stage posterior tibial tendon dysfunction secondary to the accessory navicular bone pain syndrome through the case review. Methods In our hospital from January 2011 to may 2014, the 24 cases (30 feet) of Ⅱ A stage posterior tibial tendon dysfunction secondary to the accessory navicular bone pain syndrome were treated by accessory navicular bone excision and posterior tibial tendon reconstruction combined with flexor digitorum longus tendon augmentation. The effect was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) score and the X 线 indexes. Results The 24 cases, 13 males (17 feet), 11 females (13 feet);13 right feet, 17 left feet; aged 27~54 years old, 43.5 on average; 6~24 months in the course of disease, 10.5 months on average, were followed up for 12~36 months, 16.5 months on average. The AOFAS score was 43.3±2.1 before the operation and 83.3±2.6 at the final follow-up, the difference was statistically significant (P<0.05). The X 线 indexes were greatly improved too: Lateral the angle between the first metatarsal bone and the talus was changed from (8.7±4.6)° to (4.8±2.2)° (P<0.05);the inclination of calcaneus changed from (13.5±2.1)° to (21.1±3.2)° (P<0.05); and the talonavicular coverage angle changed from (12.1±2.3)° to (6.1±1.3)° (P<0.05). Conclusions The accessory navicular bone excision and posterior tibial tendon reconstruction combined with flexor digitorum longus tendon augmentation is a reliable treatment for the Ⅱ A stage posterior tibial tendon dysfunction secondary to the accessory navicular bone pain syndrome. Making a reasonable operation scheme based on the symptoms and signs and the accurate imaging assessment to confirm the stage of disease is very important for avoiding the postoperative complications to ensure the long-term satisfactory effect.%目的：通过病例回顾探讨副舟骨切除胫后肌腱止点前移联合趾长屈肌腱转位术治疗足副舟骨疼痛综合征继发Ⅱ A 期胫后肌腱失能的疗效。方法回顾上海市长宁区光华中西医结合医院2011年1月至2014年5月收治的足副舟骨疼痛综合征继发Ⅱ A 期胫后肌腱失能患者24例（30足）。所有患者行副舟骨切除胫后肌腱止点前移联合趾长屈肌腱转位术，根据美国足踝外科协会（AOFAS）评分法及足踝的相关 X 线指标进行术前、末次随访相关评估。结果该组共观察了男13例（17足），女11例（13足）；右足13例，左足17例。平均年龄43.5岁（27～54岁）；病程时间为6～24个月，平均10.5个月，术后24例患者随访12～36个月，平均16.5个月。术前 AOFAS 评分（43.3±2.1）分，末次随访（83.3±2.6）分，差异有统计学意义（P<0.05）。末次随访相关 X 线指标较术前改善明显，侧位第1跖骨距骨角术前（8.7±4.6）°，末次随访（4.8±2.2）°，P<0.05；跟骨倾斜角术前（13.5±2.1）°，末次随访（21.1±3.2）°，P<0.05；距舟覆盖角术前（12.1±2.3）°，末次随访（6.1±1.3）°，P<0.05；优良率81.8%，且未发生明显并发症。结论副舟骨切除胫后肌腱止点前移联合趾长屈肌腱转位术是治疗足副舟骨疼痛综合征继发Ⅱ A 期胫后肌腱失能的一种可靠方法。根据体征、精确的影像学评估确定临床分期以选择合理的手术方案是避免术后并发症和保证长期满意疗效的基础。
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