不同截骨术式联合无头加压螺钉治疗[足母]外翻畸形的临床疗效对比  

Clinical Efficacy Comparison of Different Osteotomy Method Combined with Acutrak Screw in Treatment of Hallux Valgus

作　　者：陈浩宇[1] 黄昭华 高峻青[1] 李宏亮 王兮[1] 付记乐[1] 李卓伟[1] CHEN Haoyu;HUANG Zhaohua;GAO Junqing;LI Hongliang;WANG Xi;FU Jile;LI Zh uowei(Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong China)

机构地区：[1]广东佛山市中医院,广东佛山528000

出　　处：《中国中医骨伤科杂志》2020年第7期16-20,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：佛山市十三五医学重点专科建设项目(FSZDZK135019)。

摘　　要：目的:探究Scraf截骨与Chevron截骨联合无头加压螺钉(Acutrak螺钉)治疗[足母]外翻畸形的临床疗效。方法:回顾2015年1月至2018年6月[足母]外翻畸形患者共41例68足,男4例,女37例;年龄22~66岁,平均(43.37±9.59)岁。术中采用Chevron或Scraf截骨术式,并仅用Acutrak螺钉加压固定截骨端。根据截骨术式分为Chevron截骨组和Scraf截骨组,随访两组患者手术前后患足负重位X线片、AOFAS评分、术后并发症及患者满意度等指标来评定临床疗效。结果:随访时间13~24个月,平均(18.25±6.73)个月。影像学结果显示所有病例术后[足母]外翻角(HVA)及跖骨间角(IMA)较术前明显改善,差异有统计学意义(P<0.01),其中Chevron截骨组术后平均改善11°和4°,Scraf截骨组术后平均改善24°和9°,差异有统计学意义(P<0.01)。手术前后Chevron截骨组和Scraf截骨组AOFAS评分分别由(51.13±7.35)和(49.24±6.42)分提高至(88.77±5.53)和(89.27±5.66)分,两组患者术后评分较术前明显改善,差异有统计学意义(P<0.01)。随访两组患者未见术后并发症发生。术后两组患者对患足外观、穿鞋舒适度方面满意度评分,所有患者总满意度为90%,其中Scraf截骨组患者满意度(95%)高于Chevron截骨组满意度(84%),差异有统计学意义(P<0.05)。结论:Scraf截骨与Chevron截骨均能治疗[足母]外翻畸形,但Scraf截骨联合Acutrak螺钉能获得更强的矫正能力及更高的患者满意度。Objective:To explore the clinical efficacy of Scraf osteotomy and Chevron osteotomy method combined with the Acutrak screw internal fixation in treating hallux valgus. Methods:41 patients(68 feet)with hallux valgus deformity were included from January 2015 to June 2018. There were 4 male and 37 females with aged from 22 to 66 years and(43.37±9.59) years on average. Chevron and Scraf osteotomy were respectively used with Acutrak screws as the internal fixation in two groups. The full weight X-rays of patients were performed preoperatively and postoperatively. American Orthopaedic Foot and Ankle Society score(AOFAS scores),complications and patients’ satisfaction of preoperatively and more than 1 year postoperatively were documented. Results:Follow-up time were 13 to 24 months with(18.25±6.73) months on average. The radiologic results showed significant improvement in the HVA and IMA of all patients(Chevron:mean 11° improvement in HVA(P<0.01),mean 4° improvement IMA(P<0.01).Scraf:mean 24° improvement in HVA(P<0.01),mean 9° improvement IMA(P<0.01)). The preoperatively and postoperatively AOFAS scores of Chevron osteotomy group and Scraf osteotomy group were significantly increased from(51.13±7.35) and(49.24±6.42) points to(88.77±5.53) and(89.27±5.66) points respectively(P<0.01). No postoperative complications were observed in all patients. The whole satisfaction rate of the appearance of the foot and the comfort of wearing shoes after the operation were about 90%. Rate in the Scraf osteotomy group(95%) was higher than the Chevron osteotomy group(84%),and the statistically significant difference was found between those two groups. Conclusion:Both Scraf and Chevron osteotomy with Acutrak screw can well treat hallux valgus,but Scraf osteotomy method can obtain stronger correction ability and higher patient satisfaction.

关 键 词：截骨矫形 [足母]外翻 无头加压螺钉 疗效对比 

分 类 号：R681.8[医药卫生—骨科学]