Chevron截骨术治疗拇外翻的近期临床观察
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摘要
目的：观察chevron截骨术治疗拇外翻的近期疗效。
方法：选取江苏省中医院骨伤科2010年1月至2012年3月间符合拇外翻诊断标准的患者14例,共20足,采用chevron截骨术治疗,在手术前后拍摄负重位X线片,测量拇外翻角(HAV),第1、2跖骨间角(IMA)及近端关节面固定角(PASA),根据Mann分型将患者分为轻度拇外翻、中度拇外翻、重度拇外翻,应用AOFAS评分量表对患者进行评分。采用SPSS19.0软件对相关数据进行统计分析。
结果：
1.手术前后进行功能评分,AOFAS评分由47.60±7.05分上升至81.20±4.58分。经统计学分析(P<0.05),具有统计学意义。2.手术前后负重正位X线片测量,平均FIVA由32.45。减至11.38。,IMA由11.60。减至6.09°, PASA由19.12。减至8.18。,各指标在手术前后对比均有统计学差异(P<0.05)。3.无论是轻度拇外翻、中度拇外翻,还是重度拇外翻的患者,术后X线片测量结果与AOFAS量表评分值均与术前差异明显,P<0.05,有统计学意义。4.患者术后近期均取得较满意疗效,无患者因手术效果不满意而要求再次手术。
结论：
1. Chevron截骨术治疗拇外翻的近期疗效确切,在矫正畸形,缓解疼痛,患者自我满意度等方面,疗效满意,是临床治疗拇外翻的一种常用方法。
2.拇外翻的异常解剖结构在手术以后得到恢复,重建了力学平衡。其负重位X线测量及功能评分对术前指导及手术疗效的评估有重要意义。
Objective:To explore the chevron technique for treatment of hallux valgus. Methods:chevron osteotomies were performed on20feet in14patients during2010.1-2012.3.
Before and after operation in shooting weight a X-ray measurement hallux valgus Angle (HAV),1,2metatarsal Angle between (IMA),and proximal articular surface fixed Angle (PASA), according to Mann classification will patients into mild hallux valgus, moderate, and severe hallux valgus hallux valgus, application AOFAS rating scale rating to patients. The SPSS19.0software related data of statistical analysis. Results:
1.AOFAS seore was47.607.05while81.20±4.58Preoperatively. The Parameters are of statistieal signifieanee.
2.ComPared with the PreoPerative weight bearing X-ray measurement, HVA was redueed to11.38°from32.45°, IMA was6.09°from11.60°, PASA was8.18°form19.12°The Parameters are of statistieal signifieanee.
3.Whether mild, moderate hallux valgus hallux valgus, or severe hallux valgus patients, postoperative X-ray measurement results and AOFAS rating scale value are significant difference with preoperative, P<0.05, with a statistical significance.
4.Hallux valgus postoperative patients are satisfied with curative effect, no patients for operation results are not satisfactory and require a second surgery. Conclusions:
1. Chevron osteotomy hallux valgus treatment of recent symptoms, and in the correct deformity, pain, patients self satisfaction, etc, and the results were satisfactory, is the clinical treatment of hallux valgus a common method.
2.After the operation restoration hallux valgus abnormal in anatomical structure, rebuilt the mechanics balance. A full load of hallux valgus X line measurement and functional score for preoperative guidance and the effectiveness of surgery to have the important meaning.
方法：选取江苏省中医院骨伤科2010年1月至2012年3月间符合拇外翻诊断标准的患者14例,共20足,采用chevron截骨术治疗,在手术前后拍摄负重位X线片,测量拇外翻角(HAV),第1、2跖骨间角(IMA)及近端关节面固定角(PASA),根据Mann分型将患者分为轻度拇外翻、中度拇外翻、重度拇外翻,应用AOFAS评分量表对患者进行评分。采用SPSS19.0软件对相关数据进行统计分析。
结果：
1.手术前后进行功能评分,AOFAS评分由47.60±7.05分上升至81.20±4.58分。经统计学分析(P<0.05),具有统计学意义。2.手术前后负重正位X线片测量,平均FIVA由32.45。减至11.38。,IMA由11.60。减至6.09°, PASA由19.12。减至8.18。,各指标在手术前后对比均有统计学差异(P<0.05)。3.无论是轻度拇外翻、中度拇外翻,还是重度拇外翻的患者,术后X线片测量结果与AOFAS量表评分值均与术前差异明显,P<0.05,有统计学意义。4.患者术后近期均取得较满意疗效,无患者因手术效果不满意而要求再次手术。
结论：
1. Chevron截骨术治疗拇外翻的近期疗效确切,在矫正畸形,缓解疼痛,患者自我满意度等方面,疗效满意,是临床治疗拇外翻的一种常用方法。
2.拇外翻的异常解剖结构在手术以后得到恢复,重建了力学平衡。其负重位X线测量及功能评分对术前指导及手术疗效的评估有重要意义。
Objective:To explore the chevron technique for treatment of hallux valgus. Methods:chevron osteotomies were performed on20feet in14patients during2010.1-2012.3.
Before and after operation in shooting weight a X-ray measurement hallux valgus Angle (HAV),1,2metatarsal Angle between (IMA),and proximal articular surface fixed Angle (PASA), according to Mann classification will patients into mild hallux valgus, moderate, and severe hallux valgus hallux valgus, application AOFAS rating scale rating to patients. The SPSS19.0software related data of statistical analysis. Results:
1.AOFAS seore was47.607.05while81.20±4.58Preoperatively. The Parameters are of statistieal signifieanee.
2.ComPared with the PreoPerative weight bearing X-ray measurement, HVA was redueed to11.38°from32.45°, IMA was6.09°from11.60°, PASA was8.18°form19.12°The Parameters are of statistieal signifieanee.
3.Whether mild, moderate hallux valgus hallux valgus, or severe hallux valgus patients, postoperative X-ray measurement results and AOFAS rating scale value are significant difference with preoperative, P<0.05, with a statistical significance.
4.Hallux valgus postoperative patients are satisfied with curative effect, no patients for operation results are not satisfactory and require a second surgery. Conclusions:
1. Chevron osteotomy hallux valgus treatment of recent symptoms, and in the correct deformity, pain, patients self satisfaction, etc, and the results were satisfactory, is the clinical treatment of hallux valgus a common method.
2.After the operation restoration hallux valgus abnormal in anatomical structure, rebuilt the mechanics balance. A full load of hallux valgus X line measurement and functional score for preoperative guidance and the effectiveness of surgery to have the important meaning.
引文
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[2]Kato TWatanabe S.The etiology of hallux valgus in Japan. Clin Orthop.1981, 157: 78
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[4]Lam SF. Hogdson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population.J Bone Joint Surg. 1958: 40A: 1058-1062.
[5]田世杰,刘崇静.87例拇外翻的病因和疗效分析.中华外科杂志,1984,22(1)：545-547.
[6]铃木良平.足外科学.第一版.天津：天津科学技术出版社.
[7]Sim-Fook L.Hogdson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg 40A:1058-1062, 1958.
[8]#12
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[11]Kato T, Watanabe S. The etiology of hallux valgus in Japan. Clin Orthop RelatRes. 1981; 157:78-81.
[12]Piqu'e-Vidal C, Sol'e MT, Antich J. Hallux valgus inheritance:pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg. 2007;46: 149-54.
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[19]Ferrari J, Hopkinson DA, Linney AD. Size and shape differences between male and female foot bones:is the female foot predisposed to hallux abducto valgus deformity? J Am Podiatr Med Assoc.2004; 94:434-52.
[20]Dykyj D, Ateshian GA, Trepal MJ, MacDonald LR. Articular geometry of the medial tarsometatarsal joint in the foot:comparison of metatarsus primus adductus and metatarsus primus rectus. J Foot Ankle Surg.2001; 40: 357-65.
[21]O'Connor K, Bragdon G, Baumhauer JF. Sexual dimorphism of the foot and ankle. Orthop Clin North Am. 2006; 37: 569-74.
[22]朱丽华,等.成人拇外翻的外科治疗。中华骨科杂志,1987,7：183.
[23]高战鳌,马顺前,程斌,等.微创治疗中重度拇趾外翻临床效果[J]。临床骨科杂志,2007,10(3)：205-206。
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[25]McLennan R:Prevalence of hallux valgus in a neolithic New Guinea population.Lancet 1.1966: 1395-1400.
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[28]Clark HR, Veith RG, Hansen ST Jr. Adolescent bunions treated by the modified Lapidus procedure. Bull Hosp Jt Dis Orthop Inst.1987; 47: 109-22.
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[30]Mann RA, Coughlin MJ. Hallux valgus-etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981; 157: 31-41.
[31]Hansen ST Jr. Hallux valgus surgery. Morton and Lapidus were right! Clin Podiatr Med Surg. 1996; 13:347-54.
[32]Fulp MJ:Surgical approaches to equinus deformities. In McGlamry ED (ed):Reconstructive Surgery of the Foot and Leg. New York, Intercontinental Medical Book Corp,1974, pp 275-282.
[33]Truslow W, Metatarsal primus varus or hallux valgus[J]. J Bone Joint Surg,1925.(7): 48
[34]周树全,王善良等,第一跖骨头楔形内翻截骨术治疗拇外翻.中国医师杂志,2005增刊：230-231.
[35]Mann RA. Symposium on foot and ankle. St Louis Mosby Company,1983:157-178.
[36]Kilmarfin TE, Wallace WA. First metatarsal head shape in jurenile hallux adducte valgus [J]. JBone Joint Surg (Am),1991,30(5):506.
[37]朱伯通,戴尅戎.骨科手术学.北京：人民卫生出版社,2004.2092.
[38]Komeda T, Tanaka Y, Takakura Y, et al. Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimentional coordinate system.,J Orthop Sci.2001;6(2):108-110.
[39]Huang CK, Kitaoka HB, An KN, Chao EY. Biomechanical evaluation of longitudinal archstability.Foot Ankle,1993, Jul-Aug; 14(6):353-357.
[40]温建民,桑志成等.正常足与拇外翻足前足承重比例与跖骨头下压力的研究.中国骨伤.2003,16(11)：641-643.
[41]Mitchell CL, Flemimg JL, Allen R, Glenney C, Sanford GA: Osteotomy-bunionectomy for hallux valgus.J Bonr Joint Surg, 1958, 49A: 41-60.
[42]Coughlin, M.J.:Hallux Valgus. J Bone Joint Surg. June 1996, 68A(No.6): 932-966.
[43]温建民,正常足与拇外翻足的足底压力研究,中华骨科杂志1999,19：346-348.
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[2]Kato TWatanabe S.The etiology of hallux valgus in Japan. Clin Orthop.1981, 157: 78
[3]Shine IB:Incidence of hallux valgus in a partially shoe-wearing community.Br Med J.1965: 6: 1648-1650.
[4]Lam SF. Hogdson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population.J Bone Joint Surg. 1958: 40A: 1058-1062.
[5]田世杰,刘崇静.87例拇外翻的病因和疗效分析.中华外科杂志,1984,22(1)：545-547.
[6]铃木良平.足外科学.第一版.天津：天津科学技术出版社.
[7]Sim-Fook L.Hogdson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg 40A:1058-1062, 1958.
[8]#12
[9]Barnicot NA, Hardy RH. The position of the hallux in West Africans. J Anat.1955; 89: 355-61.
[10]MacLennan R. Prevalence of hallux valgus in neolithic New Guinea population.Lancet. 1966; 1: 1398-400.
[11]Kato T, Watanabe S. The etiology of hallux valgus in Japan. Clin Orthop RelatRes. 1981; 157:78-81.
[12]Piqu'e-Vidal C, Sol'e MT, Antich J. Hallux valgus inheritance:pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg. 2007;46: 149-54.
[13Saro C, Andr'en B, Wildemyr Z, Fell"ander-Tsai L.Outcome after distal metatarsal osteotomy for hallux valgus:a prospective randomized controlled trial of two methods. Foot Ankle Int.2007; 28:778-87.
[14]Thordarson D, Ebramzadeh E, Moorthy M, Lee J, Rudicel S.Correlation of hallux valgus surgical outcome with AOFAS forefoot score and radiological parameters.Foot Ankle Int.2005; 26:122-7.
[15]Frey C, Thompson F, Smith J, Sanders M, Horstman H. American Orthopaedic Foot and Ankle Society women's shoe survey. Foot Ankle.1993;14: 78-81.
[16]Shine IB. Incidence of hallux valgus in a partially shoe-wearing community. Br Med J.1965; 1: 1648-50.
[17]Guti'errez Carbonell P, Sebasti'a Forcada E, Betoldi Lizier G. Factores morfol'ogicos que influyen en el hallux valgus. Revista de Orthpedia Traumatologi'a.l998;42: 356-62.
[18]Ferrari J, Malone-Lee J. The shape of the metatarsal head as a cause of hallux abductovalgus. Foot Ankle Int. 2002;23: 236-42.
[19]Ferrari J, Hopkinson DA, Linney AD. Size and shape differences between male and female foot bones:is the female foot predisposed to hallux abducto valgus deformity? J Am Podiatr Med Assoc.2004; 94:434-52.
[20]Dykyj D, Ateshian GA, Trepal MJ, MacDonald LR. Articular geometry of the medial tarsometatarsal joint in the foot:comparison of metatarsus primus adductus and metatarsus primus rectus. J Foot Ankle Surg.2001; 40: 357-65.
[21]O'Connor K, Bragdon G, Baumhauer JF. Sexual dimorphism of the foot and ankle. Orthop Clin North Am. 2006; 37: 569-74.
[22]朱丽华,等.成人拇外翻的外科治疗。中华骨科杂志,1987,7：183.
[23]高战鳌,马顺前,程斌,等.微创治疗中重度拇趾外翻临床效果[J]。临床骨科杂志,2007,10(3)：205-206。
[24]Hardy RA, Clapham JCR:Observations on halluxvalgus. J Bone Joint Surg 33B:376-391,1951.
[25]McLennan R:Prevalence of hallux valgus in a neolithic New Guinea population.Lancet 1.1966: 1395-1400.
[26]温建民,梁朝等,遗传因素与拇外翻相关性的临床研究,中国矫形外科杂志,2006：14(7)：516-518.
[27]Carl A, Ross S, Evanski P, Waugh T. Hypermobility in hallux valgus. Foot Ankle.1988; 8: 64-70.
[28]Clark HR, Veith RG, Hansen ST Jr. Adolescent bunions treated by the modified Lapidus procedure. Bull Hosp Jt Dis Orthop Inst.1987; 47: 109-22.
[29]顾湘杰,马昕,鲍根喜等。韧带松弛度对拇外翻成因的影响。上海医科大学学报.1998,25(3)：184.
[30]Mann RA, Coughlin MJ. Hallux valgus-etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981; 157: 31-41.
[31]Hansen ST Jr. Hallux valgus surgery. Morton and Lapidus were right! Clin Podiatr Med Surg. 1996; 13:347-54.
[32]Fulp MJ:Surgical approaches to equinus deformities. In McGlamry ED (ed):Reconstructive Surgery of the Foot and Leg. New York, Intercontinental Medical Book Corp,1974, pp 275-282.
[33]Truslow W, Metatarsal primus varus or hallux valgus[J]. J Bone Joint Surg,1925.(7): 48
[34]周树全,王善良等,第一跖骨头楔形内翻截骨术治疗拇外翻.中国医师杂志,2005增刊：230-231.
[35]Mann RA. Symposium on foot and ankle. St Louis Mosby Company,1983:157-178.
[36]Kilmarfin TE, Wallace WA. First metatarsal head shape in jurenile hallux adducte valgus [J]. JBone Joint Surg (Am),1991,30(5):506.
[37]朱伯通,戴尅戎.骨科手术学.北京：人民卫生出版社,2004.2092.
[38]Komeda T, Tanaka Y, Takakura Y, et al. Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimentional coordinate system.,J Orthop Sci.2001;6(2):108-110.
[39]Huang CK, Kitaoka HB, An KN, Chao EY. Biomechanical evaluation of longitudinal archstability.Foot Ankle,1993, Jul-Aug; 14(6):353-357.
[40]温建民,桑志成等.正常足与拇外翻足前足承重比例与跖骨头下压力的研究.中国骨伤.2003,16(11)：641-643.
[41]Mitchell CL, Flemimg JL, Allen R, Glenney C, Sanford GA: Osteotomy-bunionectomy for hallux valgus.J Bonr Joint Surg, 1958, 49A: 41-60.
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