摘要
目的探讨比较第1跖骨远端斜行截骨和Youngswick截骨术对Ⅲ、Ⅳ期踇僵硬的临床疗效。方法回顾性分析2013年5月至2018年12月在宁波市第六医院接受第1跖骨远端截骨治疗的29例(33足)Ⅲ、Ⅳ期踇僵硬患者的临床资料。其中男10例,女19例,年龄45~67岁,平均(56±6)岁。17例18足行第1跖骨远端斜行截骨术,12例15足行Youngswick截骨术。比较两组术前、末次随访时疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踇趾功能评分、第1跖趾关节活动度、第1跖趾关节间隙。手术前后数据比较应用配对t检验。结果所有患者手术均获得成功,第1跖骨远端斜行截骨和Youngswick截骨的手术时间分别为(1.1±0.2)、(1.3±0.1)h,术中出血分别为35(25,36)ml、35(30,40)ml。随访时间为12~46个月。所有患者术后未发生骨不愈合、延迟愈合、转移性跖骨痛、感染以及跖骨头坏死,无需再次手术。与术前相比,两组术后疼痛VAS评分明显下降(Z=-3.8,-3.5,均P<0.01),第1跖趾关节背伸活动度显著增加(Z=-3.7、-3.4,均P<0.01),AOFAS踇趾功能评分明显增加(t=28.0、15.4,均P<0.05),第1跖趾关节间隙亦有显著改善(t=17.7、14.6,均P<0.05)。两种手术方式术后VAS评分、第1跖趾关节背伸活动度和Horton指数差异均无统计学意义(Z=-1.3、-0.3、-0.4,均P>0.05),AOFAS评分差异亦无统计学意义(t=0.1,P>0.05),但Youngswick截骨术组末次随访时关节间隙更大[(2.4±0.3)mm比(2.1±0.4)mm,t=2.2,P=0.04]。结论第1跖骨远端斜行截骨术和Youngswick截骨术都能有效缓解踇僵硬患者的疼痛,增加第1跖趾关节背伸活动度和关节间隙,下沉第1跖骨头,可以延缓踇僵硬病程的发展,改善患者生活状态。
Objective To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of gradeⅢandⅣhallux rigidus.Methods Totally 29 patients(33 feet)suffered from gradeⅢandⅣhallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively.Among them,there were 10 males and 19 females.The average age was(56±6)years.Seventeen cases(18 feet)underwent distal oblique osteotomy of the first metatarsal,12 cases(15 feet)underwent the Youngswick osteotomy.The overall clinical evaluations were investigated before the operation and at the final follow-up,included the visual analogue scale(VAS)of the pain,American Orthopedic Foot&Ankle Society(AOFAS)scores,the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space.The data before and after operation were compared by paired t test and non-parametric rank sum test.Results The operation time were(1.1±0.2)hours and(1.3±0.1)hours,and the intraoperative bleeding was 35(25,36)ml and 35(30,40)ml in the distal oblique osteotomy and Youngswick osteotomy respectively.All patients were followed up for 12 to 46 months.No nonunion or delayed union occurred in all patients.All patients did not need to be operated again,and no complications such as transferring metatarsalgia,infection and osteonecrosis occurred.In the two groups,the pain VAS score decreased significantly(Z=-3.8,-3.5,both P<0.01),the first metatarsophalangeal joint dorsal extension activity increased(Z=-3.7,-3.4,both P<0.01),the AOFAS score increased(t=28.0,15.4,both P<0.05)and the first metatarsophalangeal joint space also improved significantly(t=17.7,14.6,P<0.05)after the operation.There was no significant difference in VAS score,the first metatarsophalangeal joint activity and Horton index between the two groups(Z=-1.3,-0.3,-0.4,all P>0.05),and there was no statistical difference inAOFAS score(t=0.1,P>0.05).But compared with it in the fir
作者
许文博
张峰
贺萍萍
朱彦昭
姚陆丰
申成春
汪海清
任昊旸
黄雷
Xu Wenbo;Zhang Feng;He Pingping;Zhu Yanzhao;Yao Lufeng;Shen Chengchun;Wang Haiqing;Ren Haoyang;Huang Lei(Department of Foot and Ankle Surgery,Ningbo NO.6 Hospital,Ningbo 315040,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第27期2144-2149,共6页
National Medical Journal of China
关键词
跖趾关节
踇僵硬
第1跖骨远端截骨术
关节活动度
Metatarsophalangeal joint
Hallux rigidus
The first distal metatarsal osteotomy
Range of motion
