籽骨复位对[足母]外翻伴籽骨脱位术后的影响  

The Effect of Hallux Valgus Deformity Correction with Tibial Sesamoid Reduction

作　　者：杨杰[1] 梁晓军[1] 王军虎[1] 李毅[1] 鹿军 赵宏谋[1] 田锋[1] Yang Jie;Liang Xiaojun;Wang Junhu(Department of Foot and Ankle Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科诊疗中心,陕西西安710054

出　　处：《实用骨科杂志》2020年第7期596-599,608,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨经胫侧籽骨悬吊复位对[足母]外翻畸形伴籽骨脱位术后影像学及临床预后的影响,并评估其安全性及并发症。方法自2016年1月至2017年12月在我院足踝外科诊疗中心收治的[足母]外翻畸形伴籽骨脱位手术患者中选择30例纳入A组,在截骨矫形及外侧软组织松解的基础上,均采用经胫侧籽骨悬吊复位治疗[足母]籽骨脱位;同时收集整理同时期在我科实施截骨矫形及外侧软组织松解患者30例纳入B组。所有病例均采用Scarf截骨术(必要时加Akin截骨术)。随访影像学上测量足母外翻角(hallux valgus angle,HVA)、1~2跖骨间角(1~2 inermetatarsal angle,1~2 IMA)、跖骨远端关节面角(distal metatarsal articular angle,DMAA)和胫侧籽骨位置(tibial sesamoid position,TSP)。临床预后通过美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)前足评分和并发症进行评价。结果两组患者均获得随访,随访时间6~26个月,平均随访时间(14.1±5.34)个月。两组间术后HVA、1~2 IMA和DMAA矫正程度比较,差异无统计学意义(P>0.05);A组TSP和AOFAS评分改善程度明显优于B组,差异具有统计学意义(P<0.05)。结论在[足母]外翻畸形矫正术时,经胫侧籽骨悬吊复位可以明显改善术后籽骨位置,并提高临床预后评分,但对于HVA、1~2 IMA和DMAA的矫正无明显影响。Objective To investigate the effect of hallux valgus deformity correction with tibial sesamoid suspension reduction on imaging and clinical outcome,and to evaluate its safety and complications.Methods From January 2016 to December 2017,30 patients who underwent hallux valgus correction surgery with sesamoid dislocation in our hospital were included in group A.All of them accepted osteotomy,lateral soft tissue release and tibial sesamoid suspension reduction.Another 30 cases who underwent osteotomy and lateral soft tissue release in our department from January 2016 to December 2017 were included in B group.All cases were treated with Scarf osteotomy(combined with Akin osteotomy if necessary).After follow-up,HVA,1~2 IMA,DMAA and the tibial sesamoid position(TSP)were measured on imaging,and the clinical outcome was evaluated with the AOFAS.Results Two groups of the patients were followed up for 6-26 months,the average follow-up time was(14.1±5.34)months.There was no significant difference in the correction effect of HVA,1~2 IMA and DMAA between the two groups preopertion and post-operation(P>0.05).The correction degree of TSP and AOFAS score in the A group was significantly better than that in the control group(P<0.05).Conclusion In hallux valgus surgery,tibial sesamoid suspension reduction can obviously correct the position of sesamoid and improve the clinical outcome,but there is no effect on HVA,1~2 IMA and DMAA.

关 键 词：籽骨 复位 [足母]外翻 预后 

分 类 号：R684.7[医药卫生—骨科学]