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外翻的病例对照研究  

Comparison of clinical effects of the amputation of the adductor pollicis through medial and traditional approach in treating hallux valgus

作　　者：殷勇[1] 谢利民[1] 

机构地区：[1]中国中医科学院广安门医院骨科,北京100053

出　　处：《中国骨伤》2011年第1期44-47,共4页China Journal of Orthopaedics and Traumatology

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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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外翻角(HAA)及术后疼痛VAS评分,比较两组患者治疗前后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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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�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,P0.001]. 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,P0.001）;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,P0.001）. The post-operatively HAA between two g

关 键 词：外科手术 微创性 外翻 病例对照研究 

分 类 号：R681.8[医药卫生—骨科学]