拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术治疗重度拇外翻
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摘要
目的介绍拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术在重度拇外翻治疗中的作用。方法回顾分析我科2007年1月～2017年6月所行拇外翻病例2123例(3865足);其中女性2082例,男性41例;年龄22～84岁,平均56.39岁。重度拇外翻病人207例(253足),其中124例(163足)采用拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术治疗;83例(90足)采用改良小切口第1跖骨截骨术治疗;轻、中度拇外翻病人1916例(3612足),采用改良小切口第1跖骨截骨术治疗。结果全部病例均获随访,随访时间3～30个月。联合手术组术后第1跖趾关节外翻角(HVA)(2.80±1.11)°,第1、2跖骨间角(5.68±1.62)°,通过统计学分析发现联合手术组与仅采用改良小切口第1跖骨截骨术的重度拇外翻组术后HVA差异,存在统计学意义(P=0.044)。术后疗效评定:联合手术组优84.67%,良14.52%,差0.81%。仅采用改良小切口第1跖骨截骨术的重度拇外翻组中,优79.52%,良19.82%,差1.20%。仅采用改良小切口第1跖骨截骨术的轻、中度拇外翻组中,优82.83%;良17.07%,差0.10%。结论对于重度拇外翻病例,采用拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术对HVA的改善要优于仅采用单一手术,且术后并发症更少,病人满意度更高。
Objective To introduce the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus.Methods The clinical data of 2123 patients(3865 feet)who had hallux valgus between January 2007 and June 2017 were reviewed.There were 2082 females and 41 males with an average age of 56.39 years.Among these patients,207 patients(253 feet)had severe hallux valgus.124 patients(163 feet)who had severe hallux valgus had received the combination of two kind of minimally invasive osteotomy which in the first proximal phalanx and metatarsal.83 patients(90 feet)who had severe hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.1916 patients(3612 feet)who had mild and moderate hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.Results All patients were followed for 3～30 months.In the combined surgery group,HVA after surgery was(2.8±1.11)°,IMA after surgery was(5.68±1.62)°.The difference between combined surgery group and uncombined surgery group has statistical significance(P=0.044)in HVA after surgery among severe hallux valgus patients.In the combined surgery group,84.67% of patients had excellent results,14.52% good,and 0.81% bad.In the uncombined surgery group of severe hallux valgus,79.52% of patients had excellent results,19.82% good,and 1.20% bad.In the uncombined surgery group of mild and moderate hallux valgus,82.83% of patients had excellent results,17.07% good,and 0.10% bad.Conclusion the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus had the better HVA,less complication,higher satisfaction degree after surgery.
Objective To introduce the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus.Methods The clinical data of 2123 patients(3865 feet)who had hallux valgus between January 2007 and June 2017 were reviewed.There were 2082 females and 41 males with an average age of 56.39 years.Among these patients,207 patients(253 feet)had severe hallux valgus.124 patients(163 feet)who had severe hallux valgus had received the combination of two kind of minimally invasive osteotomy which in the first proximal phalanx and metatarsal.83 patients(90 feet)who had severe hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.1916 patients(3612 feet)who had mild and moderate hallux valgus had just received one kind of minimally invasive osteotomy which in the first metatarsal.Results All patients were followed for 3～30 months.In the combined surgery group,HVA after surgery was(2.8±1.11)°,IMA after surgery was(5.68±1.62)°.The difference between combined surgery group and uncombined surgery group has statistical significance(P=0.044)in HVA after surgery among severe hallux valgus patients.In the combined surgery group,84.67% of patients had excellent results,14.52% good,and 0.81% bad.In the uncombined surgery group of severe hallux valgus,79.52% of patients had excellent results,19.82% good,and 1.20% bad.In the uncombined surgery group of mild and moderate hallux valgus,82.83% of patients had excellent results,17.07% good,and 0.10% bad.Conclusion the combination of two kind of minimally invasive osteotomy in treatment of severe hallux valgus had the better HVA,less complication,higher satisfaction degree after surgery.
引文
[1] Garrow AP,Papageorgiou A,Silman AJ,et al.The grading of hallux valgus.The Manchester Scale[J].Journal of the American Podiatric Medical Association,2001,91(2):74.
[2] Iliou K,Paraskevas G,Kanavaros P,et al.Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus[J].Medical Principles & Practice International Journal of the Kuwait University Health Science Centre,2016,25(1):21-24.
[3] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot & Ankle International,1994,15(7):349-353.
[4] 温建民,桑志成,林新晓,等.小切口手法治疗拇外翻临床研究——附535例(986足)研究报告[J].中国矫形外科杂志,2002,1:26-29.
[5] 孙卫东,温建民,胡海威,等.康复疗法在中西医结合治疗拇外翻术后的应用效果观察[J].现代中西医结合杂志,2010,19(22):2731-2733.
[6] Oliva F,Longo UG,Maffulli N.Minimally invasive hallux valgus correction[J].Orthopedic Clinics of North America,2009,40(4):525-530.
[7] 赵思桥,马顺前,高战鳌,等.改良小切口第1跖骨截骨术治疗(足母)外翻[J].中国矫形外科杂志,2016,24(1):39-44.
[8] 陈宝兴.拇外翻的治疗[J].中华骨科杂志,2001,21(3):133-133.
[9] Lechler P,Feldmann C,K?ck FX,et al.Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure:a prospective matched group analysis[J].Arch Orthop Trauma Surg,2012,132(1):9-13.
[10] 陈希龙,李益亮,孙绍裘,等.微创技术与传统术式治疗足拇外翻疗效比较的 Meta 分析[J].湖南中医杂志,2013(12):121-123.
[11] 张毅,黄继春.拇外翻的临床病理改变与术后并发症的分析[J].实用骨科杂志,2012,18(6):569-570.
[2] Iliou K,Paraskevas G,Kanavaros P,et al.Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus[J].Medical Principles & Practice International Journal of the Kuwait University Health Science Centre,2016,25(1):21-24.
[3] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot & Ankle International,1994,15(7):349-353.
[4] 温建民,桑志成,林新晓,等.小切口手法治疗拇外翻临床研究——附535例(986足)研究报告[J].中国矫形外科杂志,2002,1:26-29.
[5] 孙卫东,温建民,胡海威,等.康复疗法在中西医结合治疗拇外翻术后的应用效果观察[J].现代中西医结合杂志,2010,19(22):2731-2733.
[6] Oliva F,Longo UG,Maffulli N.Minimally invasive hallux valgus correction[J].Orthopedic Clinics of North America,2009,40(4):525-530.
[7] 赵思桥,马顺前,高战鳌,等.改良小切口第1跖骨截骨术治疗(足母)外翻[J].中国矫形外科杂志,2016,24(1):39-44.
[8] 陈宝兴.拇外翻的治疗[J].中华骨科杂志,2001,21(3):133-133.
[9] Lechler P,Feldmann C,K?ck FX,et al.Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure:a prospective matched group analysis[J].Arch Orthop Trauma Surg,2012,132(1):9-13.
[10] 陈希龙,李益亮,孙绍裘,等.微创技术与传统术式治疗足拇外翻疗效比较的 Meta 分析[J].湖南中医杂志,2013(12):121-123.
[11] 张毅,黄继春.拇外翻的临床病理改变与术后并发症的分析[J].实用骨科杂志,2012,18(6):569-570.