• 短篇论著 •    

改良第一跖骨远端V形截骨术治疗轻中度拇外翻

高翔,赵晓涛,陈玉宏,张殿英   

  1. 天津市第五中心医院
  • 收稿日期:2013-03-06 修回日期:2013-06-30 出版日期:2013-10-15 发布日期:2013-10-15
  • 通讯作者: 高翔

Modified V Shaped Osteotomy on the First Distal Metatarsal for Mild to Moderate Hallux Valgus

  • Received:2013-03-06 Revised:2013-06-30 Published:2013-10-15 Online:2013-10-15
  • Contact: Xiang GAO

摘要:

【摘要】  目的  介绍并评价改良第一跖骨远端V形截骨术治疗轻中度拇外翻的临床疗效。  方法  选取采用改良第一跖骨远端V形截骨术治疗合并转移性跖痛的轻中度拇外翻患者18例(24足)。测量并比较手术前后拇外翻角(HVA)、第一、二跖骨间角(IMA1~2)、患足前足底压力/足底总压力、第1~5跖骨头下压力/前足底压力分布改变;使用AOFAS评分评价疗效。      结果       术后HVA、IMA1~2低于术 前(11.8±1.8vs30.2±3.3,6.6±1.0vs13.8±1.9,P<0.05),AOFAS评分高于术前(92.8±3.4vs58.2±8.6,P<0.05)。术后患足前足底及第1~5跖骨头下压力分布较术前明显接近正常值标准。术后第一跖骨长度平均短缩小于2mm;术后截骨处平均愈合时间为12周,无一例患足出现截骨后不愈合或跖骨头坏死。结论    第一跖骨远端V形截骨术可有效治疗合并转移性跖痛的轻中度拇外翻,矫形效果确切,并发症少,值得推广。

关键词: 拇外翻, 截骨术, 矫形外科手术, 跖痛症, 足底压力

Abstract: [Abstract] Objective To introduce the surgical strategy of modified V shaped osteotomy on the first distal metatarsal, and to discuss its benefit for the treatment of mild to moderate hallux valgus. Methods Totally 18 hallux valgus patients with refer metatarsalgia (24 feet) were operated by modified V shaped osteotomy on the first distal metatarsal from January in 2008 to January in 2012, all females, with an average age of 42.6 years (range, 30 to 55 years). Pre- and postoperation, HVA and IMA1~2 were measured by X-Ray. Plantar pressure was measured by Plantar pressure measurement system. AOFAS scoring system was employed to evaluate clinical curative effect. Results HVA was corrected from 30.2°±3.3° preoperatively to 11.8°±1.8° at the last visit(P<0.05), IMA1~2 was corrected from 13.8°±1.9° preoperatively to 6.6°±1.0° at the last visit(P<0.05), The plantar pressure return to normal postoperatively, AOFAS score was raised from (58.2±8.6) to (92.8±3.4)(P<0.05) postoperatively. Conclusion The surgical strategy of modified V shaped osteotomy on the first distal metatarsal is proved to be effective in treating mild to moderate hallux valgus with refer metatarsalgia, in terms of strong capability of correction, lower incidence of nonunion, allowance of early weight bearing.

Key words: hallux valgus, Osteotomy, orthopedic procedures, refer metatarsalgia, plantar pressure