跖骨近端斜形截骨短缩复位术治疗重度跖趾关节合并跖痛症临床分析
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摘要
1.研究目的
通过回顾性分析,分析跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症的有效性、安全性。
2.方法
研究观察病例自2005年10月-2011年3月,于中国中医科学院望京医院关节二科接受跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症患者,年龄(66.97±9.03岁),男女比例2：21,共69例,共80足(左足40,右足40),共89个跖趾关节[74个第二跖趾关节(左39,右35),15个第三跖趾关节(左5,右10)],术后随访时间(12-72月),平均时间32月,其中经长期随访、资料完整共65例,共74足(左36,右38),83个跖趾关节[68个第二跖趾关节(左足35,右足33),15个第三跖趾关节(左足5,右足10)],(脱落病例均为失访所致)。重度跖趾关节脱位合并跖痛症患者均于术前及术后拍摄足部负重位X线片,并测量手术前后相关临床指标。按照手术前后自身对照的方法进行统计,观察分析拇外翻角度(HAV, Hallux abductor valgus angle)、第一、二跖骨间角(IMA,intermetatarsal angle)、跖骨长度、跖趾关节间隙、跖趾关节夹角等指标,应用美国足与踝关节协会(AOFAS,American Orthopaedic Foot and Ankle Society)、美国足踝医师学会(ACFAS, American college of foot and ankle surgeons)、视觉模拟量表(VAS, Visual analogue scale),对术前及术后临床观察指标进行统计学分析,验证该技术的有效性。
3.结果
3.1.X线指标
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症,对术前及术后足部负重位X线测量,进行统计学分析。HAV、IMA、跖骨长度、跖趾骨夹角、跖趾关节间隙等临床观察指标经统计学分析有差异,有统计学意义(P<0.05)。
3.2临床疗效
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症经临床验证,经长期随访,疗效肯定。经过长期随访,手术前后AOFAS、ACFAS、VAS等临床评分经统计学分析,均有差异,具有统计学意义(P<0.05)。
术前AOFAS评分为(35.49±6.01)分,术后为(91.29±3.77)分,术后与术前AOFAS经统计学分析有差异,具有统计学意义(P<0.05)
术前ACFAS评分为(34.06±7.54)分,术后为(90.43±3.88)分,术后与术前ACFAS经统计学分析有差异,具有统计学意义(P<0.05)。
术前VAS评分为(8.14±0.97)分,术后为(1.14±0.73)分,术后与术前VAS经统计学分析有差异,具有统计学意义(P<0.05)。
4.结论
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症,疗效确切,安全性高,有临床指导意义。
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症最大程度纠正患者跖趾关节脱位畸形,改善患者前足底疼痛的症状,证明本术式临床治疗的有效性,患者满意度高。
1.Objective
To analyze the effectiveness and security of metatarsal proximal osteotomy and shortening surgery in the treatment of the dislocation of severe metatarsophalangeal joint with plantar pain through the retrospective study.
2.Method
The cases in research are the patients who receive the treatment in Joint Departments II of Wangjing Hospital from October2005to March2011.Patients'age66.97±9.03years, male to female ratio2:21, a total of69patients,80feet (left40right40),89cases of metatarsophalangeal joints,74cases of the second metatarsophal-angeal joints (left39, right35),15cases of the third metatarsophalangeal joints (left5, right10).Postoperative follow-up time12to72months, the average of follow-up time32months. After the long-term follow-up,65paitiets in case left include74feet (left36, right38),83cases of metatarsophalangeal joints,68cases of the second metata-rsophalangeal joints (left35, right33),15cases of the third metatarsophalangeal joints (left5, right10), to observe and analyze the hallux valgus angle, intermetatarsal angle, metatarsal length, the metatarsophalangeal, joint gap, the metatarsus phalanx angle before and after surgery. AOFAS, ACFAS and VAS in the clinical evaluation were all analyzed to verify the validity of the technology before and after surgery.
3Results
3.1.X-ray indicators
The HAV, IM, metatarsal length, metatarsus phalanx angle, and metatarsophalangeal joint gap were all statistically significant before and after surgery(P<0.05).
3.2The clinical efficacy
The treatment of severe metatarsophalangeal joint dislocation with plantar pain is effective in clinical validation after the long-term follow-up. The preoperative AOFAS score (35.49±6.01) and postoperative AOFAS score (91.29±3.77).The AOFAS score was statistically significant (P<0.05) before and after surgery. The Preoperative ACFAS score (34.06±7.54) and postoperative ACFAS score (90.43±3.88).The ACFAS score was statistically significant (P<0.05) before and after surgery. The Preoperative VAS score (8.14±0.97) and postoperative VAS score (1.14±0.73), The VAS score was statistically significant (P<0.05) before and after surgery.
4Conclusion
Metatarsal proximal osteotomy and shortening surgery in the treatment of the dislocation of severe metatarsophalangeal joint with plantar pain is very effective. The treatment of the dislocation of severe metatarsophalangeal joint with plantar pain can both correct the deformity of metatarsophalangealjoint dislocation, improve the forefoot pain symptom, and prove the effectiveness of the clinical treatment of the surgery.
通过回顾性分析,分析跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症的有效性、安全性。
2.方法
研究观察病例自2005年10月-2011年3月,于中国中医科学院望京医院关节二科接受跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症患者,年龄(66.97±9.03岁),男女比例2：21,共69例,共80足(左足40,右足40),共89个跖趾关节[74个第二跖趾关节(左39,右35),15个第三跖趾关节(左5,右10)],术后随访时间(12-72月),平均时间32月,其中经长期随访、资料完整共65例,共74足(左36,右38),83个跖趾关节[68个第二跖趾关节(左足35,右足33),15个第三跖趾关节(左足5,右足10)],(脱落病例均为失访所致)。重度跖趾关节脱位合并跖痛症患者均于术前及术后拍摄足部负重位X线片,并测量手术前后相关临床指标。按照手术前后自身对照的方法进行统计,观察分析拇外翻角度(HAV, Hallux abductor valgus angle)、第一、二跖骨间角(IMA,intermetatarsal angle)、跖骨长度、跖趾关节间隙、跖趾关节夹角等指标,应用美国足与踝关节协会(AOFAS,American Orthopaedic Foot and Ankle Society)、美国足踝医师学会(ACFAS, American college of foot and ankle surgeons)、视觉模拟量表(VAS, Visual analogue scale),对术前及术后临床观察指标进行统计学分析,验证该技术的有效性。
3.结果
3.1.X线指标
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症,对术前及术后足部负重位X线测量,进行统计学分析。HAV、IMA、跖骨长度、跖趾骨夹角、跖趾关节间隙等临床观察指标经统计学分析有差异,有统计学意义(P<0.05)。
3.2临床疗效
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症经临床验证,经长期随访,疗效肯定。经过长期随访,手术前后AOFAS、ACFAS、VAS等临床评分经统计学分析,均有差异,具有统计学意义(P<0.05)。
术前AOFAS评分为(35.49±6.01)分,术后为(91.29±3.77)分,术后与术前AOFAS经统计学分析有差异,具有统计学意义(P<0.05)
术前ACFAS评分为(34.06±7.54)分,术后为(90.43±3.88)分,术后与术前ACFAS经统计学分析有差异,具有统计学意义(P<0.05)。
术前VAS评分为(8.14±0.97)分,术后为(1.14±0.73)分,术后与术前VAS经统计学分析有差异,具有统计学意义(P<0.05)。
4.结论
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症,疗效确切,安全性高,有临床指导意义。
跖骨近端斜形截骨短缩复位术治疗重度跖趾关节脱位合并跖痛症最大程度纠正患者跖趾关节脱位畸形,改善患者前足底疼痛的症状,证明本术式临床治疗的有效性,患者满意度高。
1.Objective
To analyze the effectiveness and security of metatarsal proximal osteotomy and shortening surgery in the treatment of the dislocation of severe metatarsophalangeal joint with plantar pain through the retrospective study.
2.Method
The cases in research are the patients who receive the treatment in Joint Departments II of Wangjing Hospital from October2005to March2011.Patients'age66.97±9.03years, male to female ratio2:21, a total of69patients,80feet (left40right40),89cases of metatarsophalangeal joints,74cases of the second metatarsophal-angeal joints (left39, right35),15cases of the third metatarsophalangeal joints (left5, right10).Postoperative follow-up time12to72months, the average of follow-up time32months. After the long-term follow-up,65paitiets in case left include74feet (left36, right38),83cases of metatarsophalangeal joints,68cases of the second metata-rsophalangeal joints (left35, right33),15cases of the third metatarsophalangeal joints (left5, right10), to observe and analyze the hallux valgus angle, intermetatarsal angle, metatarsal length, the metatarsophalangeal, joint gap, the metatarsus phalanx angle before and after surgery. AOFAS, ACFAS and VAS in the clinical evaluation were all analyzed to verify the validity of the technology before and after surgery.
3Results
3.1.X-ray indicators
The HAV, IM, metatarsal length, metatarsus phalanx angle, and metatarsophalangeal joint gap were all statistically significant before and after surgery(P<0.05).
3.2The clinical efficacy
The treatment of severe metatarsophalangeal joint dislocation with plantar pain is effective in clinical validation after the long-term follow-up. The preoperative AOFAS score (35.49±6.01) and postoperative AOFAS score (91.29±3.77).The AOFAS score was statistically significant (P<0.05) before and after surgery. The Preoperative ACFAS score (34.06±7.54) and postoperative ACFAS score (90.43±3.88).The ACFAS score was statistically significant (P<0.05) before and after surgery. The Preoperative VAS score (8.14±0.97) and postoperative VAS score (1.14±0.73), The VAS score was statistically significant (P<0.05) before and after surgery.
4Conclusion
Metatarsal proximal osteotomy and shortening surgery in the treatment of the dislocation of severe metatarsophalangeal joint with plantar pain is very effective. The treatment of the dislocation of severe metatarsophalangeal joint with plantar pain can both correct the deformity of metatarsophalangealjoint dislocation, improve the forefoot pain symptom, and prove the effectiveness of the clinical treatment of the surgery.
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