摘要
目的探讨拇外翻术后转移性跖骨痛的危险因素,为拇外翻术后前足底疼痛的预防及治疗提供理论参考依据。方法采用回顾性研究方法,对2010年5月～2012年8月在笔者所在科室住院治疗的47例拇外翻患者(67足)进行术后随访,20例术后出现转移性跖骨痛足为观察组,47例术后未出现转移性跖骨痛足为对照组,随访时间平均(17.74±6.23)个月,研究人员按研究方案填写回访表,内容包括年龄、随访时间、拇趾外翻角、第一至二跖骨间角、第一跖骨短缩度、第一跖骨近端关节固定角,足内侧纵弓角,第一跖趾关节活动度、第一跖楔关节矢状面活动度、推进期第一跖骨头下压力及拇趾下压力。对可能影响拇外翻术后转移性跖骨痛的高危因素进行单因素分析与Logistic多元回归分析。结果 Logistic回归分析结果显示,术后拇趾跖趾关节活动度,第一跖楔关节活动度,第一跖骨(相对第二跖骨短缩)为拇外翻患者出现转移性跖骨痛的危险因素。结论术前针对每一只拇外翻患足的具体病理变化进行细致的分析,选择相应的手术方法,注意尽可能避免第一跖骨过度短缩、第一跖楔关节过度活动,而且要注意术后拇趾功能的恢复,只有这样才能有效降低患足出现转移性跖骨痛的机率,提高手术的疗效。
Objective To explore the risk fatctors that maybe lead to transfer metatarsalgia after surgery for correct hallux valgus deformity. Methods Retrospective study was used with 47 patients （67 feet）. 20 feet with post operative transfer metatarsalgia were put in observation group and another 47 feet without the symptom in control group, average fellow-up time was （17.74 ± 6.23） months. An questionnaire was provided to fill for every subject. Many factors such as age , interval to fellow-up, HVA, I-II IMA, the shorten amout of the first metatarsal（ relative to the second metatarsal ）, PASA, motive range of the first metatarsophalangeal joint and the first metatarsal-cuneiform joint,force under the thrumb and the seccond metatarsal head in the pushing stage were taken into account in the study. All these factors were evaluated by singe-factor and multiple-factors logistic regression analysis. Results Factors including the relative shorten of the first metatarsal, range of motion of the first metatarsophalangeal joint and the first metatarsal-cuneiform joint are the risk of transfer metatarsalgia. Conclusion Before surgery, an elaborative evaluation should be made to find the real etiology of a hallux valgus foot . Caution should be paid to avoid excessive relative shortening of the first metatarsal and any factor which limits range of the 1st metatarsophalangeal joint and leads the hypermobility of the first metatarsal-cuneiform to decrease the occurrence of postoperative transfer metatarsalgia.
出处
《中国医药科学》
2012年第24期9-11,24,共4页
China Medicine And Pharmacy
基金
北京市自然科学基金资助项目(7102167)
关键词
拇外翻
转移性跖骨痛
高危因素
Hallux valgus
Transfer metatarsalgia
High risk factor
