第一跖楔关节矢状面活动范围的研究及临床意义  

Sagittal mobility study on the first tarsometatarsal joint in hallux valgus patients and its clinical values

作　　者：桂鉴超[1] 顾湘杰[2] 王黎明[1] 沈海琦[1] 喻忠[1] 马昕[2] 陈劲松[2] 王旭[2] 黄河[1] 

机构地区：[1]南京医科大学附属南京第一医院骨科,210006 [2]上海华山医院骨科

出　　处：《中华外科杂志》2005年第4期259-262,共4页Chinese Journal of Surgery

摘　　要：目的探讨第一跖楔关节(FTJ)矢状面的活动范围与拇外翻的病理生理机制及治疗的关系。方法采用Lee方法对300例正常足和200例拇外翻足进行FTJ矢状面活动范围测量,并统计分析与其相关的因素。结果300例正常足的FTJ矢状面活动范围为8 4°±2 3°, 200例拇外翻足的FTJ矢状面活动范围为11 7°±3 2°,两组比较,差异具有统计学意义(P<0 01)。FTJ矢状面的过度活动与跖楔关节的形态(P<0 05)、楔骨间隙有无分离(P<0 01)、有无转移性跖骨头下疼痛(P<0 01)、FTJ关节炎(P<0 01)有关, 而与拇外翻角(HVA)、跖间角(IMA)、第2跖骨干内侧皮质肥厚无关(P>0 05)。结论Lee方法简单,结果可靠。HVA、IMA的测定不能代替FTJ矢状面活动范围的测定,临床上应常规测量FTJ矢状面的活动范围,对于Ⅰ型FTJ的拇外翻患者显得尤为必要。对于FTJ增大,同时有转移性跖骨头下疼痛、楔骨间隙分离、FTJ关节炎的患者,应行Lapidus手术(跖楔关节融合术)。Objective To study sagittal mobility about the FTJ(first tarsometatarsal joint) and its relationship with the pathophysiology and treatment of hallux valgus patients. Methods According to ~Lee′s method, FTJ sagittal mobility of 300 normal feet and 200 hallux valgus was measured, and its correlative factors were statistically analysed.Results FTJ sagittal mobility of 300 normal feet was 8.4°±2.3°, and that of 200 hallux valgus was 11.7°±3.2°, the difference was significant .The normal range of FTJ sagittal mobility was less than 13°. The sagittal overmotion of FTJ had relation to the anatomical configuration of FTJ(P<0.05), intercuneiform splitting(P<0.01), transferred pain under the second metatarsal head(P<0.01), and FTJ osteoarthritis(P<0.01) had no relation to HVA (hallux valgus angle), IMA(intermetatarsal angle),second metatarsus medial diaphyseal cortex hypertrophy(P>0.05).Conclusion^Lee′s method is convenient and accurate. Both HVA and IMA can not represent the sagittal mobility measurement of FTJ, which should be routinely evaluated , especially for hallux valgus patients with type I FTJ. Lapidus procedure should be considered for patients with larger FTJ in combination with transferred pain under the second metatarsal head, intercuneiform splitting, FTJ osteoarthritis.

关 键 词：矢状面 拇外翻 跖骨 关节 转移性 HVA 正常 肥厚 皮质 形态 

分 类 号：R682[医药卫生—骨科学]