| 经内侧入路拇内收肌切断术与传统入路拇内收肌切断术治疗(足母)外翻的病例对照研究 |
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投稿时间：2010-11-21
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| 期刊信息：《中国骨伤》2011年，第24卷，第1期，第44-47页 |
| DOI：10.3969/j.issn.1003-0034.2011.01.013 |
| 基金项目: |
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中文摘要:
目的：比较经内侧入路拇内收肌切断术与传统入路拇内收肌切断术治疗(足母)外翻的疗效。
方法：回顾性分析2008年6月至2009年3月就诊的29例43足经拇内收肌切断术治疗的(足母)外翻患者，其中经内侧入路组(观察组)16例23足，男1例1足，女15例22足；平均年龄(57.63±17.96)岁；采用经内侧切口微创切断拇内收肌腱及外侧关节囊加常规跖骨远端截骨术，结合术中手法内翻松解、术后持续内翻位固定、被动内翻位功能锻炼。传统入路组(对照组)13例20足，均为女性；平均年龄(56.08±13.14)岁；采用传统入路拇内收肌切断术加常规跖骨远端截骨术。测量两组患者的切口总长度、治疗前后(足母)外翻角(HAA)及术后疼痛VAS评分，比较两组患者治疗前后(足母)外翻角(HAA)改善情况和疼痛变化情况。测量两组患者术中(截骨矫形后)、术后12周及术后1年牵拉(足母)趾至HAA=0°时的拉力数值，比较两组松解程度及断端再粘连程度。
结果：两组患者随访时间6～15个月，平均12个月。切口总长度观察组(3.00±0.22) cm,对照组(5.13±0.60) cm,观察组较对照组小(t=10.59,P<0.001).HAA纠正情况：观察组治疗前(34.00±7.34)°，治疗后(15.26±7.54)°，治疗前后比较差异有统计学意义(t=8.54,P<0.001);对照组治疗前(38.00±7.98)°，治疗后(15.50±7.19)°，治疗前后比较差异也有统计学意义(t=9.41,P<0.001);治疗后组间HAA比较差异无统计学意义(t=0.11,P>0.05).术后两组疼痛均逐渐减轻，从第2天至术后12周观察组VAS平均得分由(8.00±1.10)分降至(0.04±0.15)分，对照组由(5.00±0.56)分降至(0.03±0.11)分，术后2周以内观察组和对照组VAS评分差异有统计学意义(P<0.001,P<0.05),而2周以后两组差异无统计学意义(P>0.05).术中(截骨矫形后)、术后12周及术后1年牵拉(足母)趾至HAA=0°时的拉力数值，观察组分别为(14.87±0.84)、(15.26±0.92)、(17.08±0.53) N,对照组分别为(14.85±0.93)、(15.45±1.10)、(17.19±0.45) N,两组间拉力数值差异无统计学意义(P>0.05),说明两组方法松解程度、断端再粘连程度相比较无明显差异。
结论：经内侧入路切断拇内收肌腱与传统入路切断拇内收肌腱的疗效相当，而且切口数量和长度减少，未出现松解不彻底、术后粘连等并发症。是一种简便、创伤小、疗效肯定的治疗方法。 |
| 【关键词】外科手术，微创性 (足母)外翻 病例对照研究 |
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| Comparison of clinical effects of the amputation of the adductor pollicis through medial and traditional approach in treating hallux valgus |
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ABSTRACT
Objective: To compare clinical effects of the amputation of the adductor pollicis between medial approach and traditional approach in treating pollex valgus.
Methods: From Jun. 2008 to Mar. 2009,29 patients(43 feet) with hallux valgus were retrospective analyzed. The amputation of the adductor pollicis and the lateral articular capsule were done through medial approach in 16 cases(23 feet,observed group),and distal metatarsus were commonly cut,combined with inverted releasing manipulation during the operation and constant varus fixation and passive varus rehabilitation post-operation,including 1 male with 1 foot and 15 female with 22 feet,with an average age of (57.63±17.96)years. The control group consist of 13 cases with 20 feet. All cases were female with an average age of(56.08±13.14)years. The patients of the control group were treated with the amputation of the adductor pollicis through traditional approach,and the distal metatarsus were commonly cut. The length of surgical incision,HAA of pre-operation and post-operation,and VAS of post-operation were compared between two groups. Meanwhile,the pull numerical values were measured while pulling toe to HAA=0°，during operation (after the osteotomy),at the 12th week and 1st year after operation for comparing both groups' releasing and re-conglutination situation.
Results: All patients were followed up for 6 to 15 months with an average of 12 months. The total length of surgical incision in observed group were smaller less than that of control group[(3.00±0.22) cm vs(5.13±0.60) cm;t=10.59,P<0.001]. The HAA of two groups were remarkably reduced. The HAA in observed group reduced from pre-operatively (34.00±7.34)° to post-operatively (15.26±7.54)°，which had the statistical difference(t=8.54,P<0.001);and the HAA in control group were reduced from pre-operatively(38.00±7.98) to post-operatively(15.50±7.19),which also had the statistical difference(t=9.41,P<0.001). The post-operatively HAA between two groups had no statistical difference(t=0.11,P>0.05). The pains of all patients were gradually relieved after operation. From the 2nd day to 12th week after operation,the average VAS of observed group was reduced from 8.00±1.10 to 0.04±0.15,while the control group was reduced from 5.00±0.56 to 0.03±0.11. There was statistical difference in VAS within the 2nd week after operation (P<0.001,P<0.05);beyond 2nd week after operation,there was no statistical difference between two groups(P>0.05). The pull numerical values while pulling toe to HAA=0° during operation (after the osteotomy),12th week and 1st year after operation in observed group were respectively (14.87±0.84),(15.26±0.92),(17.08±0.53) N;while the control groups were respectively (14.85±0.93),(15.45±1.10),(17.19±0.45) N. There was no statistical difference between two groups(P>0.05). It means that the releasing and re-conglutination situation of two groups were no remarkable difference.
Conclusion: The clinical effect of medial approach to dissect the adductor muscle of the great toe is corresponded to traditional approach. Meanwhile,it reduced the amount and total length of surgical incisions,and had no appeared the complications of uncompleted release or conglutination. It was a convenient and effective method for pollex valgus. |
| KEY WORDS Surgical procedures,minimally invasive Hallux valgus Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 殷勇,谢利民.经内侧入路拇内收肌切断术与传统入路拇内收肌切断术治疗(足母)外翻的病例对照研究[J].中国骨伤,2011,24(1):44~47 |
| 英文格式: | YIN Yong,XIE Li-min.Comparison of clinical effects of the amputation of the adductor pollicis through medial and traditional approach in treating hallux valgus[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(1):44~47 |
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