改良的Weil截骨结合软组织松解术治疗Ⅲ型小趾囊炎的应用研究  

Application of modified Weil osteotomy combined with soft tissue release in the treatment of type Ⅲ small toe bursitis

作　　者：袁宇 程义恒 蔄元鹏 张瑞东 曲文庆 Yuan yu;Cheng yiheng;Man yuanpeng;Zhang ruidong;Qu wenqing(Foot and Ankle Surgery,Yantai Yantaishan Hospital,Yantai 264001,China)

机构地区：[1]烟台市烟台山医院足踝外科,山东烟台264001

出　　处：《足踝外科电子杂志》2022年第4期27-31,共5页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的 研究改良的Weil截骨结合软组织松解术治疗Ⅲ型小趾囊炎的可行性及临床疗效。方法 本研究对烟台市烟台山医院2018年9月至2021年9月收治的14例(17足)Ⅲ型小趾囊炎患者进行了回顾性研究,所有患者均采用Weil截骨术结合跖骨远端关节囊及内收肌等软组织松解。记录并分析:手术前后患肢第4、5跖骨间夹角,第5跖骨外翻角及小趾内翻角的变化;截骨端愈合情况;足部负重时的疼痛缓解情况;患者的满意度及复发率。采用Maryland前足评分系统对手术效果进行评价。结果 所有患者术后切口均一期愈合。14例患者术后随访6~24个月,平均11.6个月。患者的第4、5跖骨间夹角,第5跖骨外翻角及小趾内翻角手术前分别为(14.2°±4.1°)、(6.3°±2.4°)、(9.4°±3.7°),手术后分别为(5.3°±1.2°)、(1.9°±0.8°)、(5.4°±1.6°),术后的各项数值均较术前显著改善,P <0.01,差异有统计学意义。手术前后的Maryland评分分别为(72.5±8.3)分与(83.4±3.8)分,术后的前足功能较术前显著改善,P <0.01。术后跖骨截骨端的骨折愈合时间为9~16周,平均12.4周。直至末次随访,所有患者原足痛症状消失且均未复发,患者满意度较高。结论 对Ⅲ型小趾囊炎患者行Weil截骨结合软组织松解术,操作安全且具有良好的疗效。Objective To study the feasibility and clinical effect of modified Weil osteotomy combined with soft tissue release in the treatment of typeⅢsmall toe bursitis.Methods From September 2018 to September 2021,14 patients with 17 foot typeⅢsmall toe bursitis of Yantai Yantaishan Hospital were retrospectively studied.All patients were treated with Weil osteotomy combined with soft tissue release of the distal metatarsal joint capsule and adductor muscle.The following indicators are recorded and analyzed:the changes of the included angle between the fourth and fifth metatarsal bones,the fifth metatarsal valgus angle and the lesser toe varus angle of the affected limb before and after the operation;healing of osteotomy end;pain relief during foot weight bearing;the patients’satisfaction and recurrence rate.The effect of the operation was evaluated using the Maryland forefoot scoring system.Results All patients were healed at one stage.14 patients were followed up for 6 to 24 months,with an average of 11.6 months.The included angle between the fourth and fifth metatarsals,the fifth metatarsal valgus angle and the little toe varus angle were(14.2°±4.1°),(6.3°±2.4°)and(9.4°±3.7°)respectively before the operation;The postoperative values were(5.3°±1.2°),(1.9°±0.8°)and(5.4°±1.6°)respectively.The postoperative values were significantly improved compared with those before the operation(P<0.01),and the difference was statistically significant.The preoperative and postoperative Maryland scores were(72.5±8.3)points and(83.4±3.8)points,respectively.The preoperative and postoperative forefoot function was significantly improved,P<0.01.The healing time of metatarsal osteotomy end fracture after operation was 9 to 16 weeks,with an average of 12.4 weeks.Until the last follow-up,the original foot pain symptoms of all patients disappeared and didn't recur,and the patient satisfaction was high.Conclusion Weil osteotomy combined with soft tissue release is safe and effective for typeⅢsmall toe bursitis.

关 键 词：小趾囊炎 改良的Weil截骨 足部矫形 

分 类 号：R687.3[医药卫生—骨科学]