单一内侧入路拇收肌切断术结合中医手法用于拇外翻的临床研究  

The clinical effect of the combination of adductor tenotomy from a single medial incision and Chinese manipulation for hallux valgus

作　　者：殷勇[1] 钟非[2] 谢利民[1] 梁翠梅[3] 

机构地区：[1]中国中医科学院广安门医院骨科,北京100053 [2]北京中医药大学东方医院科研处,100078 [3]北京中医药大学东方医院针灸科,100078

出　　处：《国际中医中药杂志》2014年第1期20-23,共4页International Journal of Traditional Chinese Medicine

基　　金：中国中医科学院广安门医院所级科研基金课题（项目编号：2011S230）

摘　　要：目的 对比单一内侧入路拇收肌切断术结合中医手法治疗拇外翻与常规入路拇收肌切断术治疗拇外翻的临床疗效和安全性.方法 收集2012年4月至2013年4月中国中医科学院广安门医院骨科35例40足HV患者.通过区组随机法分为2组,其中治疗组17例20足;对照组18例20足（部分双足HV患者左右足分别进入两组）.治疗组采用单一内侧入路配合中医手法治疗.对照组采用常规的第一趾蹼入路切断拇收肌联合腱,再经内侧截骨手术切口行截骨术.观察两组术中、术后12周内翻位牵拉拇趾至拇外翻角（hallux valgus angle,HVA）＝0°时的拉力值;术前、术中和术后12周的HVA值;手术切口长度;术前和术后12周的拇趾–跖趾关节–趾间关节功能评分（AOFAS评分）等.比较拇收肌和外侧关节囊松解及术后再黏连程度、两组的HVA纠正能力、手术创伤和拇趾–跖趾关节–趾间关节功能改善情况.结果 治疗组和对照组术中拉力值分别为（6.04±2.52）N和（6.25±2.47）N,术后12周两组拉力值分别增加至（10.10±2.02）N和（12.05±2.08）N,组内比较差异有统计学意义（P＜0.01）;术后12周组间比较治疗组拉力值小于对照组（P＜0.05）.治疗组术前、术后第二天和术后12周HVA分别为（34.25±6.17）°、（11.20±2.97）°和（12.30±2.45）°;对照组分别为（34.40±8.12）°、（11.30±3.71）°和（14.80±2.62）°;两组术后第二天和术后12周HVA均比术前减小（P＜0.01）,但组间比较差异均无统计学意义（P＞0.05）.手术切口长度治疗组为（3.48±0.36）cm,对照组为（5.06±0.68）cm,治疗组短于对照组（P＜0.01）.治疗组术前和术后12周AOFAS评分分别为（46.75±9.12）分和（86.40±6.35）分,对照组分别为（47.40±9.26）分和（85.85±7.33）分,两组术后12周AOFAS均较术前增加（P＜0.01）,但组间比较差异无统计学意义（P＞0.05）.两组患者均未出现感染、切口不愈合或Objective To compare the clinical effect and safety of the combination of adductor tenotomy from a single medial incision and Chinese manipulation with adductor tenotomy from a routine lateral incision. Methods 35 patients in accordance with the inclusion criteria from foot and ankle clinic at the department of orthopedics, Guang＇anmen hospital were divided into 2 groups by Block randomization method. 18 cases of observed group were underwent adductor tenotomy from a single medial incision and Chinese manipulation. 17 cases of the control group were applied routine first toeweb approach to amputate adductor hallucis tendon, and then osteotomy through medial incision. The pull numerical values while pulling toe to hallux valgus angle （HVA） ： 0 o during and 12th week after operation, the HVA value of preoperation, 2nd day and 12th week after operation, the length of surgical incision, AOFAS score before and 12th week after operation were observed. The degree of releasing and postoperative adhesions of adductor hallucis and lateral articular capsule, HVA correction capability, operative trauma, and improvement of function of joint-interphalangeal joint between two groups were compared. Results The mean pull numerical values during and 12-week after operation were （6.04_2.52）N to （10.10_2.02）N at observed group, and （6.25± 2.47）N to （12.05±2.08）N in the control group. The pull numerical values of both groups 12-week after operation were increased comparing with intraoperation （P〈0.01）, and the range of the observed group was lower than the control group （P〈0.05）. The HVA ofpreoperation, 2nd day and 12th week after operation in the observed group were respectively （34.25±6.17）° , （11.20±2.97） ° and （12.30±2.45）° ; while the control groups were respectively （34.40±8.12） ° , （11.30±3.71） ° and （14.80±2.62） ° . HVA of 2nd day and 12th week after operation were decreased in both groups （P〈0.01）, while the differentiation between groups had no

关 键 词：微创 拇收肌 拇外翻 

分 类 号：R687.3[医药卫生—骨科学]