目的评价分析Scarf截骨联合软组织松解术治疗中重度足外翻的手术技术与治疗效果。方法对46例(49足)中重度足外翻行第一跖骨Scarf截骨联合远端软组织松解(内收肌腱切断、籽骨悬韧带松解+内侧囊与骨赘切除)手术,本组46例(49足)获1...目的评价分析Scarf截骨联合软组织松解术治疗中重度足外翻的手术技术与治疗效果。方法对46例(49足)中重度足外翻行第一跖骨Scarf截骨联合远端软组织松解(内收肌腱切断、籽骨悬韧带松解+内侧囊与骨赘切除)手术,本组46例(49足)获10~17个月随访,平均随访13个月。术后采用美国足踝AOFAS评分评价术前术后临床效果,记录患者术前、术后6周与末次随访时外翻角(hallux valgus angle,HVA)与第1、2跖骨间夹角(intermetatarsal angle,IMA)角度以及术前与末次随访时籽骨位置变化,结果应用SPSS 15.0统计软件进行数据比较分析。结果患者AOFAS评分由术前的平均50.03分提高到术后的87.18分,放射学检查:患者HVA由术前的平均29.43°减低到术后6周的12.79°,维持在末次随访的平均13.51°。第1、2跖骨间夹角由术前的平均15.29°减低到术后6周的5.74°,维持在末次随访的平均7.81°;籽骨位置与术前比较,显著改变(P<0.05),具有明确统计学意义;术后末次随访与术后6周影像学比较,HVA角度未见统计学改变,IMA增大约2.07°,但是患者未见临床复发症状。结论采用Scarf截骨联合远端软组织松解术治疗中、重度足外翻可以获得良好的临床效果,短期随访结果满意。展开更多
Background：There are no unified theories as to the anatomical changes that occur with hallux valgus,we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese ...Background：There are no unified theories as to the anatomical changes that occur with hallux valgus,we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.Methods：We reviewed 141 patients with hallux valgus （206 feet; 15 males,126 females; mean age,58.5 years）.These patients attended Peking University People＇s Hospital from April 2008 to March 2014.All feet had intact radiological data,obtained using the Centricity RIS/PACS system.We measured hallux valgus angle （HVA）,1-2 intermetatarsal angle （IMA）,proximal articular set angle （PASA）,distal articular set angle,hallux interphalangeal angle,metatarsocuneiform angle,size of the medial eminence of the distal first metatarsal,tibial sesamoid position,and joint congruity of the first metatarsophalangeal joint （MTPJ）.Results：We found positive correlations between the HVA and IMA （r =0.279,P 〈 0.01） and HVA and PASA （r =0.358,P 〈 0.01）,but not for IMA and PASA （P 〉 0.05）.Feet were divided into three groups based on HVA severity.IMA （P 〈 0.05） and PASA （P 〈 0.05） in the mild group were significantly lower than that in the moderate and severe groups,with no significant difference determined for IMA or PASA between the moderate and severe groups （P 〉 0.05）.Feet were then grouped based on the shape of the first metatarsal head.Using this grouping,HVA was significant higher in the rounded shape （19.92°） than in a flat shape （17.66°）.The size of the medial eminence of the distal first metatarsal was positively correlated with HVA （r =0.185,P 〈 0.01）.The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.Conclusions：PASA enlargement is an adaptive change during early hallux valgus formation,and decompensation leads to subdislocation in the first MTPJ.A rounded first metatarsal head would thus predispose a foot to hallu展开更多
目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chev...目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chevron或者Scarf截骨基础上采用外侧软组织松解。术后24周,评估患者术后恢复情况[拇外翻角(HVA)、第1、2跖骨间夹角(IMA)],踝功能评分,肿胀值,疼痛程度视觉模拟评分法(VAS)评分,统计患者骨性愈合时间。结果:术前,两组拇外翻患者IMA、HVA比较差异均无统计学意义(P>0.05),术后,两组拇外翻患者IMA、HVA均降低,试验组IMA、HVA均低于参照组(P<0.05)。术后两组拇外翻患者美国骨科足踝外科协会评分(AOFAS)评分均升高,肿胀值均降低(P<0.05);试验组AOFAS评分较参照组高,肿胀值较参照组低(P<0.05)。与术前比较,两组术后1、2、5 d VAS评分均降低(P<0.05),与术后1 d比较,两组术后2 d VAS评分均升高,术后5 d VAS评分均降低(P<0.05),与术后2 d比较,两组术后5 d VAS评分均降低(P<0.05);试验组术后2、5 d VAS评分均低于参照组(P<0.05)。试验组、参照组骨性愈合时间分别为(2.83±0.35)、(3.95±0.27)个月,试验组骨性愈合时间较参照组短(P<0.05)。结论:跖骨截骨联合外侧软组织松解能够促进拇外翻患者术后恢复,缓解术后疼痛及肿胀,有利于跖趾关节恢复,值得在临床中推广与应用。展开更多
文摘目的评价分析Scarf截骨联合软组织松解术治疗中重度足外翻的手术技术与治疗效果。方法对46例(49足)中重度足外翻行第一跖骨Scarf截骨联合远端软组织松解(内收肌腱切断、籽骨悬韧带松解+内侧囊与骨赘切除)手术,本组46例(49足)获10~17个月随访,平均随访13个月。术后采用美国足踝AOFAS评分评价术前术后临床效果,记录患者术前、术后6周与末次随访时外翻角(hallux valgus angle,HVA)与第1、2跖骨间夹角(intermetatarsal angle,IMA)角度以及术前与末次随访时籽骨位置变化,结果应用SPSS 15.0统计软件进行数据比较分析。结果患者AOFAS评分由术前的平均50.03分提高到术后的87.18分,放射学检查:患者HVA由术前的平均29.43°减低到术后6周的12.79°,维持在末次随访的平均13.51°。第1、2跖骨间夹角由术前的平均15.29°减低到术后6周的5.74°,维持在末次随访的平均7.81°;籽骨位置与术前比较,显著改变(P<0.05),具有明确统计学意义;术后末次随访与术后6周影像学比较,HVA角度未见统计学改变,IMA增大约2.07°,但是患者未见临床复发症状。结论采用Scarf截骨联合远端软组织松解术治疗中、重度足外翻可以获得良好的临床效果,短期随访结果满意。
文摘Background：There are no unified theories as to the anatomical changes that occur with hallux valgus,we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.Methods：We reviewed 141 patients with hallux valgus （206 feet; 15 males,126 females; mean age,58.5 years）.These patients attended Peking University People＇s Hospital from April 2008 to March 2014.All feet had intact radiological data,obtained using the Centricity RIS/PACS system.We measured hallux valgus angle （HVA）,1-2 intermetatarsal angle （IMA）,proximal articular set angle （PASA）,distal articular set angle,hallux interphalangeal angle,metatarsocuneiform angle,size of the medial eminence of the distal first metatarsal,tibial sesamoid position,and joint congruity of the first metatarsophalangeal joint （MTPJ）.Results：We found positive correlations between the HVA and IMA （r =0.279,P 〈 0.01） and HVA and PASA （r =0.358,P 〈 0.01）,but not for IMA and PASA （P 〉 0.05）.Feet were divided into three groups based on HVA severity.IMA （P 〈 0.05） and PASA （P 〈 0.05） in the mild group were significantly lower than that in the moderate and severe groups,with no significant difference determined for IMA or PASA between the moderate and severe groups （P 〉 0.05）.Feet were then grouped based on the shape of the first metatarsal head.Using this grouping,HVA was significant higher in the rounded shape （19.92°） than in a flat shape （17.66°）.The size of the medial eminence of the distal first metatarsal was positively correlated with HVA （r =0.185,P 〈 0.01）.The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.Conclusions：PASA enlargement is an adaptive change during early hallux valgus formation,and decompensation leads to subdislocation in the first MTPJ.A rounded first metatarsal head would thus predispose a foot to hallu
文摘目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chevron或者Scarf截骨基础上采用外侧软组织松解。术后24周,评估患者术后恢复情况[拇外翻角(HVA)、第1、2跖骨间夹角(IMA)],踝功能评分,肿胀值,疼痛程度视觉模拟评分法(VAS)评分,统计患者骨性愈合时间。结果:术前,两组拇外翻患者IMA、HVA比较差异均无统计学意义(P>0.05),术后,两组拇外翻患者IMA、HVA均降低,试验组IMA、HVA均低于参照组(P<0.05)。术后两组拇外翻患者美国骨科足踝外科协会评分(AOFAS)评分均升高,肿胀值均降低(P<0.05);试验组AOFAS评分较参照组高,肿胀值较参照组低(P<0.05)。与术前比较,两组术后1、2、5 d VAS评分均降低(P<0.05),与术后1 d比较,两组术后2 d VAS评分均升高,术后5 d VAS评分均降低(P<0.05),与术后2 d比较,两组术后5 d VAS评分均降低(P<0.05);试验组术后2、5 d VAS评分均低于参照组(P<0.05)。试验组、参照组骨性愈合时间分别为(2.83±0.35)、(3.95±0.27)个月,试验组骨性愈合时间较参照组短(P<0.05)。结论:跖骨截骨联合外侧软组织松解能够促进拇外翻患者术后恢复,缓解术后疼痛及肿胀,有利于跖趾关节恢复,值得在临床中推广与应用。
