改良中西医结合微创术联合Akin截骨术治疗中重度拇外翻的疗效观察

杨艳军, 白子兴, 曹旭含, 孙承颐, 陈思, 赵豪程, 温建民, 孙卫东

杨艳军, 白子兴, 曹旭含, 孙承颐, 陈思, 赵豪程, 温建民, 孙卫东. 改良中西医结合微创术联合Akin截骨术治疗中重度拇外翻的疗效观察[J]. 实用临床医药杂志, 2022, 26(17): 81-86. DOI: 10.7619/jcmp.20214852
引用本文: 杨艳军, 白子兴, 曹旭含, 孙承颐, 陈思, 赵豪程, 温建民, 孙卫东. 改良中西医结合微创术联合Akin截骨术治疗中重度拇外翻的疗效观察[J]. 实用临床医药杂志, 2022, 26(17): 81-86. DOI: 10.7619/jcmp.20214852
YANG Yanjun, BAI Zixing, CAO Xuhan, SUN Chengyi, CHEN Si, ZHAO Haocheng, WEN Jianmin, SUN Weidong. Effect of modified minimally invasive surgery of integrated traditional Chinese and western medicine combined with Akin osteotomy in treatment of patients with moderate to severe hallux valgus[J]. Journal of Clinical Medicine in Practice, 2022, 26(17): 81-86. DOI: 10.7619/jcmp.20214852
Citation: YANG Yanjun, BAI Zixing, CAO Xuhan, SUN Chengyi, CHEN Si, ZHAO Haocheng, WEN Jianmin, SUN Weidong. Effect of modified minimally invasive surgery of integrated traditional Chinese and western medicine combined with Akin osteotomy in treatment of patients with moderate to severe hallux valgus[J]. Journal of Clinical Medicine in Practice, 2022, 26(17): 81-86. DOI: 10.7619/jcmp.20214852

改良中西医结合微创术联合Akin截骨术治疗中重度拇外翻的疗效观察

基金项目: 

首都临床诊疗技术研究及示范应用项目 Z191100006619024

详细信息
    通讯作者:

    孙卫东, E-mail: sunweidong8239@aliyun.com

  • 中图分类号: R687;R682.1

Effect of modified minimally invasive surgery of integrated traditional Chinese and western medicine combined with Akin osteotomy in treatment of patients with moderate to severe hallux valgus

  • 摘要:
    目的 

    探讨改良中西医结合微创术联合Akin截骨术治疗中重度拇外翻的临床疗效。

    方法 

    选取60例(114足)中重度拇外翻患者,根据不同手术方式分为观察组和对照组,每组30例。观察组采用改良中西医结合微创术联合Akin截骨术治疗,对照组采用单纯中西医结合微创术治疗。比较2组术前、术后6周、末次随访时拇外翻角(HVA)、第一与第二跖骨间夹角(IMA)、远端关节面固有角(DASA)、美国足踝外科协会(AOFAS)评分。

    结果 

    2组患者手术过程顺利,术后均愈合良好,未见骨折不愈合或延迟愈合、内侧皮神经永久性损伤及跖骨头坏死等并发症。对照组、观察组HVA由术前的(39.14±6.62)、(40.20±7.15)°降低到术后6周的(9.45±3.70)、(5.89±1.70)°和末次随访的(14.94±4.63)、(8.54±2.14)°,差异有统计学意义(P<0.01)。对照组、观察组IMA由术前的(13.74±2.83)、(13.66±2.52)°降低到术后6周的(10.35±3.08)、(10.11±2.57)°和末次随访的(8.11±2.71)、(7.62±2.85)°, 2组间差异无统计学意义(P>0.05)。对照组、观察组DASA由术前的(11.75±4.73)、(11.58±4.20)°降低到术后6周的(9.87±2.53)、(7.19±1.25)°和末次随访的(7.88±1.35)、(5.74±1.07)°, 差异有统计学意义(P<0.01)。对照组、观察组AOFAS评分由术前的(48.45±7.88)、(49.61±8.77)分升高到术后6周的(83.29±3.91)、(88.74±4.41)分和末次随访的(88.67±3.87)、(95.53±2.60)分,差异有统计学意义(P<0.01)。

    结论 

    改良中西医结合微创术联合Akin截骨术治疗中重度外翻的效果显著,术后无明显的并发症,复发和术后转移性跖痛症的概率较低。

    Abstract:
    Objective 

    To investigate the clinical efficacy of modified minimally invasive surgery of integrated traditional Chinese and western medicine combined with Akin osteotomy in the treatment of patients with moderate to severe hallux valgus.

    Methods 

    Sixty patients (114 feet) with moderate to severe hallux valgus were selected and divided into observation group and control group according to different surgical methods, with 30 cases in each group. The observation group was treated with modified minimally invasive surgery of integrated traditional Chinese and western medicine and Akin osteotomy, while the control group was treated with simple minimally invasive surgery of integrated traditional Chinese and western medicine. The hallux valgus angle (HVA), the intermetatarsal angle (IMA) between the first and second metatarsal bones, the distal articular set angle (DASA) and the score of the American Orthopedic Foot and Ankle Society (AOFAS) were compared between the two groups before operation, 6 weeks after operation and at the last follow-up.

    Results 

    The patients in both group finished operations successfully, the postoperative healing was good, and no complications such as nonunion or delayed union of fracture, permanent injury of medial cutaneous nerve and necrosis of metatarsal head were observed. The HVA in the control group and the observation group decreased from (39.14±6.62)°, (40.20±7.15)° before operation to (9.45±3.70)°, (5.89±1.70)° at 6 weeks after operation and (14.94±4.63)°, (8.54±2.14)° at the last follow-up, and there were significant differences between two groups (P < 0.01). The IMA of the control group and the observation group decreased from (13.74±2.83)°, (13.66±2.52) °before operation to (10.35± 3.08)°, (10.11±2.57)° at 6 weeks after operation and (8.11±2.71)°, (7.62±2.85)° at the last follow-up, but there were no significant differences between two groups (P > 0.05). The DASA of the control group and the observation group decreased from (11.75±4.73)°, (11.58±4.20)° before operation to (9.87±2.53)°, (7.19±1.25)°at 6 weeks after operation and (7.88±1.35)°, (5.74 ± 1.07)°at the last follow-up, and there were significant differences between two groups (P < 0.01). The AOFAS scores of the control group and the observation group increased from (48.45±7.88), (49.61±8.77) before operation to (83.29±3.91), (88.74±4.41) at 6 weeks after operation and (88.67±3.87), (95.53±2.60) at the last follow-up, and there were significant differences between two groups (P < 0.01).

    Conclusion 

    Modified minimally invasive surgery of traditional Chinese and western medicine and Akin osteotomy is effective in the treatment of patients with moderate and severe hallux valgus, the obvious postoperative complications are few, and the probability of recurrence and postoperative metastatic metatarsal pain is low.

  • 图  1   手术相关操作图

    A: 肌腱、关节松解; B、C、D: 骨赘消磨; E: 跖骨截骨; F: Akin截骨。

    图  2   改良中西医结合微创术联合Akin截骨术的典型病例康复效果

    A、B: 术前外观照显示双足拇外翻; C: 术前双足负重正位X线片显示双足中度拇外翻,第一跖趾关节脱位;
    D: 术后第2天双足正位X线片显示拇外翻纠正,第一跖趾关节复位; E: 术后6周外观照显示双足拇外翻纠正;
    F: 术后6周双足负重正位X线片; G、H: 术后6个月外观照显示双足拇外翻纠正; I: 术后6个月双足负重正位X线片。

    表  1   2组患者一般资料比较(x±s)

    组别 性别 年龄/岁 HVA/° IMA/° DASA/° AOFAS评分/分
    对照组 1 29 43.14±12.37 39.14±6.62 11.75±4.73 19.01±4.39 48.45±7.88
    观察组 2 28 42.51±11.54 40.20±7.15 11.58±4.20 19.58±4.91 49.61±8.77
    HVA: 拇外翻角; IMA: 跖间角; DASA: 远端关节面固有角; AOFAS: 美国足踝外科协会。
    下载: 导出CSV

    表  2   2组患者手术前后HVA角度比较(x±s°

    组别 术前 术后6周 末次随访
    对照组 39.14±6.62 9.45±3.70** 14.94±4.63**
    观察组 40.20±7.15 5.89±1.70**## 8.54±2.14**##
    与术前比较, **P<0.01; 与对照组比较, ##P<0.01。
    下载: 导出CSV

    表  3   2组患者手术前后IMA角度比较(x±s°

    组别 术前 术后6周 末次随访
    对照组 13.74±2.83 10.35±3.08** 8.11±2.71**
    观察组 13.66±2.52 10.11±2.57** 7.62±2.85**
    与术前比较, **P<0.01。
    下载: 导出CSV

    表  4   2组患者手术前后DASA角度比较(x±s°

    组别 术前 术后6周 末次随访
    对照组 11.75±4.73 9.87±2.53** 7.88±1.35**
    观察组 11.58±4.20 7.19±1.25**## 5.74±1.07**##
    与术前比较, **P<0.01; 与对照组比较, ##P<0.01。
    下载: 导出CSV

    表  5   2组患者术前术后AOFAS评分比较(x±s

    组别 术前 术后6周 末次随访
    对照组 48.45±7.88 83.29±3.91** 88.67±3.87**
    观察组 49.61±8.77 88.74±4.41**## 95.53±2.60**##
    与术前比较, **P<0.01; 与对照组比较, ##P<0.01。
    下载: 导出CSV
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  • 收稿日期:  2021-12-07
  • 网络出版日期:  2022-08-31
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