摘要
目的:探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法:回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例(69足),男8例(11足),女29例(58足);年龄67~83(70.03±2.87)岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分(visual analogue scale,VAS)进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会(American Orthopaedic Foot and Ankle Surgery,AOFAS)前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角(hallux valgus angle,HVA),第1、2跖间角(intermetatarsal angle,IMA)的变化情况。结果:37例(69足)患者获得随访,时间12~48(22.8±0.6)个月。术后7~10(8.00±1.21)周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA(44.30±2.84)°与末次随访(15.20±2.13)°比较,差异有统计学意义(t=65.781,P<0.05);IMA角与末次随访比较,差异无统计学意义(P>0.05)。VAS由术前的(6.73±1.48)分改善至术后6周的(2.78±0.71)分(t=3.279,P<0.05),与末次随访(1.16±1.12)分比较差异有统计学意义(t=4.859,P<0.05)。AOFAS前足评分由术前的(52.14±5.78)分提高至末次随访时的(86.70±4.86)分;结果优25足,良40足,可4足。结论:采用第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻可以明显缓解患者前足的疼痛及外观,并且稳定了第1序列,明显改善了患者的行走功能。
Objective:To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction.Methods:From March 2017 to August 2021,37 patients(69 feet)with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed,including 8 males(11 feet)and 29 females(58 feet),aged from 67 to 83 years old with an average of(70.03±2.87)years old;3 cases on the left side,2 cases on the right side and 32 cases on both sides.Visual analogue scale(VAS)was used to evaluate degree of pain relief before operation,6 weeks after operation and at the final follow-up.American Orthopaedic Foot and Ankle Surgery(AOFAS)forefoot score was used to evaluate function of the affected foot before operation and final follow-up.Hallux valgus angle(HVA)and intermetatarsal angle(IMA)were measured before operation and at the final follow-up.Results:Thirty-seven patients(69 feet)were followed up from 12 to 48 months with an average of(22.8±0.6)months.Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of(8.00±1.21)weeks after operation,without delay and nonunion.HVA was increased from(44.30±2.84)°before operation to(15.20±2.13)°at the final follow-up,and had statistical difference(t=65.781,P<0.05);while no difference in IMA before and after operation(P>0.05).VAS was decreased from(6.73±1.48)points to(2.78±0.71)points at 6 months after operation(t=3.279,P<0.05),and had difference compared with the latest follow-up(1.16±1.12)(t=4.859,P<0.05).AOFAS forefoot score increased from(52.14±5.78)preoperatively to(86.70±4.86)at the fonal follow-up,and 25 feet got excellent results,40 feet good and 4 feet fair.Conclusion:The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and
作者
马占华
潘旭月
吴俊德
祁印泽
李昕宇
陈兆军
MA Zhan-hua;PAN Xu-yue;WU Jun-de;QI Yin-ze;LI Xin-yu;CHEN Zhao-jun(Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China)
出处
《中国骨伤》
CAS
CSCD
2022年第12期1127-1131,共5页
China Journal of Orthopaedics and Traumatology
关键词
拇外翻
跖趾关节
关节融合术
截骨术
Hallux valgus
Metatarsophalangeal joint
Arthrodesis
Osteotomy
