| 微创治疗拇外翻伴小趾内翻畸形的临床观察 |
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投稿时间：2017-01-26
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| 作者 | Author | 单位 | Address | E-Mail |
| 顾始伟 |
GU Shi-wei |
西安市第一医院骨外科, 陕西 西安 710002 |
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| 杨克 |
YANG Ke |
西安市第一医院麻醉科, 陕西 西安 710002 |
Department of Anesthesiology, No.1 Hospital of Xi'an City, Xi'an 710002, Shaanxi, China |
44240263@qq.com |
| 赵思桥 |
ZHAO Si-qiao |
西安市第一医院骨外科, 陕西 西安 710002 |
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| 高战鳌 |
GAO Zhan-ao |
西安市第一医院骨外科, 陕西 西安 710002 |
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| 马顺前 |
MA Shun-qian |
西安市第一医院骨外科, 陕西 西安 710002 |
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| 张文清 |
ZHANG Wen-qing |
武警陕西总队医院外科, 陕西 西安 710002 |
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| 期刊信息：《中国骨伤》2018年，第31卷，第3期，第208-212页 |
| DOI：10.3969/j.issn.1003-0034.2018.03.003 |
| 基金项目: |
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中文摘要:
目的：探讨小切口微创截骨矫形治疗拇外翻伴小趾内翻畸形的临床效果。
方法：自2013年1月至2016年6月，采用微创小切口截骨矫形治疗168例拇外翻伴小趾内翻畸形患者，其中男7例，女161例；年龄22~75（59.3±3.5）岁。术前患者的主要临床症状为拇囊红肿、跖骨周围疼痛，拍摄患足正侧位X线片确诊为拇外翻及小趾内翻畸形。观察并比较手术时间、术后并发症情况，手术前后IMA（第1、2跖骨间角），HVA（拇外翻角），LDA（第5跖骨外翻角），MPA（小趾内翻角），IM4-5（第4、5跖骨间角）以及PASA（近端关节固定角）的变化，术后采用美国足踝外科协会拇趾-跖趾-趾间关节评分系统（AOFAS）进行功能评价。
结果：168例患者获得随访，时间6~48（28.6±3.2）个月。术后伤口愈合良好，无感染、窦道形成等并发症发生。拇外翻矫形手术时间为16~28（18.3±2.1）min；小趾内翻矫形手术时间12~26（16.9±1.8）min；IMA、HVA、LDA、MPA以及IMA 4-5分别由术前的（10.1±2.1）°、（32.6±4.2）°、（6.9±2.3）°、（18.5±5.2）°、（15.1±2.9）°矫正到术后的（8.3±2.2）°、（10.9±2.9）°、（2.7±0.4）°、（6.5±1.6）°、（8.9±1.8）°，差异有统计学意义（P<0.05）。而PASA由术前的（9.1±2.1）°矫正到术后的（8.7±1.9）°，差异无统计学意义（P>0.05）。术后AOFAS功能评分由术前的31.6±3.9提高至术后的83.7±5.2，差异有统计学意义（P>0.05）；其中优147例，良13例，可6例，差2例。
结论：微创治疗拇外翻伴小趾内翻畸形的临床效果良好，具有切口小、无缝线、外观美、手术时间短，术后功能恢复好的优点，值得在临床中推广。 |
| 【关键词】拇外翻 拇趾内翻 截骨术 微创外科手术 |
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| Minimally invasive therapy for hallux valgus with deformity of little toe varus |
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ABSTRACT
Objective: To explore clinical effect of minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision.
Methods: From January 2013 to June 2016,168 hallux valgus patients with deformity of little toe varus were treated by minimally corrective osteotomy through small incision. Among them,7 males and 161 females were aged from 22 to 75 years old with an average of(59.3±3.5) years old. Preoperative clinical manifestation mainly focus on red and swollen of bunion,pain around with metatarsal bones,and diagnosed as hallux valgus with deformity of little toe varus through small incision. Operative time,postoperative complications,pre and post-operative IMA(angle between the first and the second metatarsal bones),HVA (hallux valgus angle),LDA (valgus angle of the fifth metatarsal bones),MPA(valgus angle of little toe),IM4-5 (angle between the forth and the fifth metatarsal bones) and PASA(fixed angle of proximal joint),postoperative AOFAS score were used to evaluate foot function.
Results: One hundred and sixty-eight patients were followed up for 6 to 48 months with an average of (28.6±3.2) months. All wounds were healed well without infection,sinus tract and other complications. Operative time ranged from 16 to 28 min with an average of (18.3±2.1) min. IMA,HVA,LDA,MPA and IM A 4-5 were (10.1±2.1)°,(32.6±4.2)°,(6.9±2.3)°,(18.5±5.2)°,(15.1±2.9)°preoperatively,improved to (8.3±2.2)°,(10.9±2.9)°,(2.7±0.4)°,(6.5±1.6)°,(8.9±1.8)° postoperatively,and had significant differences before and after operation. While there was no difference in PASA before (9.1±2.1)ånd after operation(8.7±1.9)°. AOFAS score were improved from (31.6±3.9) before operation to(83.7±5.2) after operation,but no significant difference(P>0.05). According to AOFAS score,147 patients obtained excellent results,13 good,6 moderate and 2 poor.
Conclusion: Minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision could obtain satisfied clinical effect,and has advantages of small incision,no stitches,beautiful appearance,shorter operation time,and rapid recovery. It is worth popularization in clinical practise. |
| KEY WORDS Hallux valgus Hallux varus Osteotomy Minimal surgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 顾始伟,杨克,赵思桥,高战鳌,马顺前,张文清.微创治疗拇外翻伴小趾内翻畸形的临床观察[J].中国骨伤,2018,31(3):208~212 |
| 英文格式: | GU Shi-wei,YANG Ke,ZHAO Si-qiao,GAO Zhan-ao,MA Shun-qian,ZHANG Wen-qing.Minimally invasive therapy for hallux valgus with deformity of little toe varus[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(3):208~212 |
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