改良小切口第1跖骨截骨术治疗外翻  

Osteotomy of first metatarsal for hallux valgus: a modified minimally invasive technique

作　　者：赵思桥[1] 马顺前 高战鳌[1] 贾晓龙[1] 夏涛[1] 顾始伟[1] 周文[1] 

机构地区：[1]西安市第一医院骨科,西安710002

出　　处：《中国矫形外科杂志》2016年第1期39-44,共6页Orthopedic Journal of China

摘　　要：[目的]介绍传统小切口第1跖骨截骨术的改良方法,并探讨这种改良在外翻治疗中的作用和疗效。[方法]回顾分析西安市第一医院骨科2002年1月~2015年1月2 105例（3 924足）行小切口第1跖骨截骨术治疗外翻病例;其中男性45例,女性2 060例;平均年龄53.72岁;双足发病1 819例,单足发病286例（左足147例,右足139例）。这些病例中,采用改良小切口第1跖骨截骨术病例共560例（1 044足）,其中男12例,女548例;平均年龄53.97岁;双足发病484例,单足发病76例（左足39例,右足37例）。未改良组术前HVA（34.39±8.94）°,IMA（15.57±2.19）°,第1跖骨长度（62.01±2.24）mm。改良组术前HVA（33.90±9.46）°,IMA（15.49±1.97）°,第1跖骨长度（61.83±1.97）mm。手术改良包括：（1）将截骨方向改为水平面自近端内侧向远端外侧、矢状位自近端跖侧向远端背侧;（2）改变传统的第1跖骨斜行截骨模式,将截骨分为角度不同的两个阶段。[结果]全部病例均获随访,随访时间3~30个月;未改良组术后HVA（8.91±1.77）°;IMA（8.57±1.41）°;第1跖骨长度（54.67±2.91）mm;第1跖骨长度较术前短缩（6.76±3.42）mm。改良组术后HVA（8.85±1.68）°;IMA（8.41±1.53）°;第1跖骨长度（59.33±1.39）mm;第1跖骨长度较术前短缩（2.58±1.99）mm。术后IMA、术后第1跖骨长度及第1跖骨短缩长度方面两组比较差异有统计学意义（P=0.030 7、0.000、0.000）。术后疗效评定：未改良组优76.05%,良23.82%,差0.13%;改良组优80.18%,良19.82%,差0例。[结论]通过对手术方法的改良,术后第1跖骨短缩明显减少,截骨端稳定性更加牢靠,畸形矫正更加充分,术后并发症发生率有所降低,外形更加美观,功能恢复更加完善,优良率更高。[Objective] To introduce a modified minimally invasive osteotomy of first metatarsal in treatment of hallux valgus. [Methods] The clinical data of 2105 patients（ 3 924 feet） who received the minimally invasive osteotomy between January 2002 and January 2015 were reviewed. There were 45 males and 2060 females with an average age of 53. 72 years,1 819 patients had operation in two feet,and 286 in single foot（ 147 left,139 right）. All patients were divided into modified group and unmodified or conventional group. In the modified group, there were 560 patients（ 1 044 feet） with 12 males and 548 females. Patients＇ age averaged 53. 97 years. 484 patients had operation in two feet,and 76 in single foot（ 39 left,37 right）.In the conventonal group,the hallux valgus angle（ HVA） was 34. 39 ± 8. 94°,the inter- metatarsal angle（ IMA） was（ 15. 57± 2. 19） °,and length of the first metatarsal was（ 62. 01 ± 2. 24） cm before osteotomy,respectively. In the modified group,HVA was（ 33. 90 ± 9. 46） °,IMA was（ 15. 49 ± 1. 97） °,and length of the first metatarsal was（ 61. 83 ± 1. 97） cm before osteotomy,respectively. The modified technique included：（ 1） the direction of osteotomy had been changed as： from the inside to the outside in the horizontal plane,from the bottom to the back in the sagittal plane,and from the proximal end to the distal in the coronal plane.（ 2） The procedures of osteotomy had been divided into two phases,each had its own angle of osteotomy. SPSS 20. 0 software was used to statistically compare the differences of HVA,IMA,length of the first metatarsal and the shortening of the first metatarsal befor and after osteotomy between two groups. [Results] All patients were followed up for 3-30 months. In the conventional group,HVA was（ 8. 91 ± 1. 77） °,IMA was（ 8. 57 ± 1. 41） °,length of the first metatarsal was（ 54. 67 ± 2. 91） cm,and shortening of the first metatarsal was（ 6. 76 ± 3. 42） cm after osteotomy,respectively. In the mod

关 键 词：外翻 改良小切口 第1跖骨 截骨术 

分 类 号：R687.3[医药卫生—骨科学]