摘要
背景:传统微创技术治疗外翻常出现第1、2趾骨间皮肤溃烂、行走不适、术后截骨端再移位、第1跖趾关节僵硬等并发症。目的:研究微创三维矫正有限固定治疗外翻的临床效果。方法:2005年7月至2010年10月采用微创技术、三维手法矫正加克氏针有限固定术治疗外翻151例281足,其中132例245足获得随访,男8例,女124例;年龄16～76岁,平均(50.2±10.3)岁;113例双侧226足,19例单侧19足。按Mann外翻分类:轻度98足,中度122足,重度25足。对比手术前后外翻角(HVA)、第1、2跖骨间角(IMA)、趾骨间角(IPA)、近侧关节固定角(PASA)、远侧关节固定角(DASA)、跖楔角(MCA)、美国足与踝关节协会足趾-跖趾关节-趾间关节功能评分标准(AOFAS)评分及前足底压力。结果:随访时间为2～6.25年,平均3.9年。236足外翻畸形完全矫正无复发,6足复发,3足第一跖趾关节炎行关节融合术。前足第2、3跖骨头底部胼胝体的疼痛早期均获得缓解,后期233足的胼胝体疼痛逐渐完全消失,12足未完全消失。囊炎疼痛完全消失;6足趾背内感觉麻木;15足第一跖趾关节活动受限4°～9°。伤口均Ⅰ期愈合,无一例出现感染、骨不愈合、跖骨头坏死和克氏针断裂。术后245足X线片均示HVA<20°,IMA<10°。手术前后各角度变化、AOFAS评分比较均有统计学差异(P<0.001),前足底压力由术前第2、3、1、4、5跖骨头依次递减改善为术后第1～5跖骨头依次递减。结论:微创三维矫正有限固定治疗外翻是一种操作简单、损伤小痛苦少、下地早康复快、矫正彻底不易复发的治疗方法,疗效理想,但亦存在一定弊端如畸形纠正力度不强、转移性跖骨痛等,仍有待进一步解决。
Background： Traditional minimally invasive operation for hallux valgus may cause many complications, such as skin ulcer between the first and second toe, uncomfortable walking, re-displacement of osteotomized ends and stiffness of the first metatarsophalangeal joint. Objective： The purpose of the study is to explore the clinical outcomes of minimally invasive three-dimensional correction with limited fixation for treating hallux valgus. Methods： From July 2005 to October 2010, 151 patients with hallux valgus （281 feet） underwent minimally invasive three-dimensional correction and limited fixation with Kirschner wire. Among them, 132 patients （245 feet） were followed up. There were 8 males and 124 females. The age of the patients ranged from 16 to 76 years （50.2±10.3 years）. Some parameters, including hallux valgus angle （HVA）, intermetatarsal angle （IMA）, interphalangeal angle （IPA）, proximal articular set angle（PASA）, distal articular set angle（DASA）, metatarsal cuneiform angle（MCA）, AOFAS and propodium pressure were compared before and after the surgery. Results： The follow-up time ranged from 2 to 6.25 years （average, 3.9 years）. There were 236 feet without recurrence and 6 feet with recurrence. Metatarsophalangeal arthritis occurred in 3 feet, which were cured after arthrodesis. The pain in the corpus callosum at the bottom of the second and third metatarsal heads alleviated in the early stage, and the pain gradually disappeared in 233 feet at later stage, while the pain did not completely disappear in 12 feet. Numbness in the dorsum of thumb occurred in 6 feet. The range of motion of metatarsophalangeal joint ranged from 4~ to 9~ in 15 feet. The wounds healed at phase I in all the patients. No infection, nonunion, metatarsal head necrosis and Kirschner wire breaking occurred. Postoperative X-rays showed that HVA was less than 20 ° and IMA was less than 10° in the 245 feet. There were significant differences in the measured angles and AOFAS score before and after surgery （P 〈 0.001）. The preoperative descending order of pressure of the front foot sole was the second, third, first, fourth and fifth head of metatarsal bone, however it turned to the 1 st to the 5th head of metatarsal bone after operation. Conclusions： Minimally invasive three-dimensional correction with limited fixation is a suitable treatment for for hallux valgus. It is a simple operation with less injury, less pain, early ambulation, rapid recovery, thorough correction and less recurrence.
出处
《中国骨与关节外科》
2012年第6期505-509,共5页
Chinese Journal of Bone and Joint Surgery
关键词
微创技术
外翻
三维矫正
弹性固定
minimally invasive technique
hallux valgus
three-dimensional correction
elastic fixation
