摘要
目的总结双平面截骨术治疗合并跖骨远端关节面角(distal metatarsal articular angle,DMAA)增大的重度[足母]外翻疗效。方法回顾性分析2014年6月-2017年12月收治并获完整随访的64例(94足)合并DMAA增大的重度[足母]外翻患者临床资料。患者均接受双平面截骨术(跖骨远端Reverdin截骨术+跖骨近端开放楔形截骨术)联合Akin截骨术及软组织手术。男10例(15足),女54例(79足);年龄26~66岁,平均44.5岁。单侧34例,双侧30例。参照美国矫形足踝协会(AOFAS)Maryland跖趾关节评分系统评分为(54.3±7.4)分,疼痛视觉模拟评分(VAS)为(6.0±2.0)分。比较手术前后AOFAS Maryland跖趾关节评分系统评分及VAS评分,以及[足母]外翻角(hallux valgus angle,HVA)、第1-2跖骨间角(first-second intermetatarsal angle,1-2IMA)、DMAA、第1跖骨长度(first metatarsal length,FML)。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12~15个月,平均13.2个月。4足发生并发症,其中[足母]僵硬、内侧切口边缘皮肤感觉麻木、转移性跖痛、第1跖骨头坏死各1足。术后1年AOFAS Maryland跖趾关节评分为(89.2±7.4)分,与术前比较差异有统计学意义(t=18.427,P=0.000);其中优78足、良12足、中3足、差1足,优良率为95.7%。VAS评分为(1.5±2.0)分,较术前明显改善(t=10.238,P=0.000)。X线片复查显示术后3个月截骨均达骨性愈合。术后6个月及1年HVA、1-2IMA、DMAA与术前比较,差异均有统计学意义(P<0.05);术后1年FML与术前比较,差异无统计学意义(t=0.136,P=0.863)。结论双平面截骨术可以显著改善合并DMAA增大的重度[足母]外翻患者临床症状以及影像学参数,术后并发症少。
Objective To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle(DMAA). Methods Between June 2014 and December 2017, 64 patients(94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy(distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males(15 feet) and 54 females(79 feet)with an average age of 44.5 years(range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society(AOFAS) was 54.3±7.4 and the visual analogue scale(VAS) score was 6.0±2.0. The pre-and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle(HVA), first-second intermetatarsal angle(1-2 IMA), and the first metatarsal length(FML) were recorded and compared. Results All incisions healed by first intention. All patients were followed up 12-15 months, with an average of13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score(t=18.427, P=0.000);and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot,with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score(t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences(P<0.05) in HVA, 1-2 IMA, and DMAA between preoperation and6 months and 1 year after operation;but no significant difference was found in FML between preoperation and 1 year after operation(t=0.136, P=0.863). Conclusion For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.
作者
王欣文
汶倩
刘诚
赵恺
李毅
梁晓军
WANG Xinwen;WEN Qian;LIU Cheng;ZHAO Kai;LI Yi;LIANG Xiaojun(Department of Foot and Ankle Surgery,Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China;Department of Prevention and Health Care,the 9th Hospital of Xi’an,Xi’an Shaanxi,710054,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第1期41-45,共5页
Chinese Journal of Reparative and Reconstructive Surgery
