改良卡槽单钉Scarf截骨术与传统Scarf截骨术治疗足拇外翻畸形效果的比较  

Comparison of modified-slot single-screw Scarf osteotomy and traditional Scarf osteotomy for hallux valgus deformity

作　　者：王超[1] 王智[1] 孙超[1] 张建中[1] 王显军[1] 丁声龙 张明珠 Wang Chao;Wang Zhi;Sun Chao;Zhang Jianzhong;Wang Xianjun;Ding Shenglong;Zhang Mingzhu(Center of Foot and Ankle Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院足踝外科中心,北京100730

出　　处：《中华解剖与临床杂志》2023年第7期423-430,共8页Chinese Journal of Anatomy and Clinics

基　　金：北京市百千万人才工程(2020A43)。

摘　　要：目的比较改良卡槽单钉Scarf截骨术与传统Scarf截骨术治疗足拇外翻畸形的临床疗效。方法回顾性队列研究。纳入首都医科大学附属北京同仁医院2018年1月—2021年1月收治的39例(48足)中重度拇外翻畸形患者的临床资料,其中女37例、男2例,年龄28~77(54.5±12.2)岁。按照手术方法不同分组:改良单钉Scarf组21例(30足),均为女性,年龄29~77(52.6±13.2)岁,采用改良卡槽单钉Scarf截骨术;传统Scarf组18例(18足),女16例、男2例,年龄28~74(57.7±9.9)岁,采用传统Scarf截骨术。观察项目:(1)比较2组患者术前及末次随访时负重CT影像学指标,包括拇外翻角(HVA)、第1与第2跖骨间角(IMA)、跖骨远端关节面角(DMAA)、第1跖骨旋转角(α角)及其纠正量,以及籽骨分度(TSCG)。(2)比较2组患者手术疗效,包括美国足踝外科协会(AOFAS)前足评分和疼痛视觉模拟评分法(VAS)评分,以及术后并发症的发生情况。结果39例(48足)患者获得6~24(10.6±3.6)个月随访,术后所有患者伤口一期愈合,无感染及复发。(1)改良单钉Scarf组与传统Scarf组患者的年龄、体质量指数、随访时间、侧别、性别、分型、合并症及联合术式等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)2组患者术前的影像学指标HVA、IMA、DMAA、α角和α角纠正量,及TSCG差异均无统计学意义(P值均>0.05);术后末次随访,除传统Scarf组的DMAA与术前比较差异无统计学意义(Z=-0.54,P=0.586),2组其他指标均较术前改善(P值均<0.05)。末次随访时,2组术后HVA、HVA纠正量及IMA比较差异均无统计学意义(P值均>0.05);但改良单钉Scarf组DMAA和DMAA纠正量、IMA纠正量、α角和α角纠正量,以及TSCG均优于传统Scarf组,差异均有统计学意义(P值均<0.05)。2组术前AOFAS前足评分和VAS评分比较,术前差异均无统计学意义(P值均>0.05),术后末次随访均较术前明显改善(P值均<0.001);末次随访VAS评分2组差异无统计学意义(Z=-1.Objective This study aims to compare the clinical effect of modified-slot single-screw Scarf osteotomy and traditional Scarf osteotomy for treatment of hallux valgus deformity.Methods A retrospective cohort study was conducted.The clinical data of 39 patients(48 feet)with moderate and severe hallux valgus admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2021 were included(37 females and 2 males,aged 28-77[54.5±12.2]years).According to different surgical methods,21 patients(30 feet)in the modified single-screw Scarf group were female aged 29-77(52.6±13.2)years and were treated with the modified osteotomy.The traditional Scarf group consisted of 18 patients(18 feet)including 2 males and 16 females aged 28-74(57.7±9.9)years who were treated with the traditional osteotomy.The observation items were as follows.(1)The weight-bearing CT radiographic parameters of the two groups were compared before surgery and at the last follow-up.These parameters included hallux valgus angle(HVA),first and second intermetatarsal angle(IMA),distal metatarsal articular surface angle,(DMAA),first metatarsal rotation angle(αangle),and amount of correction,tibial sesamoid coronal grading(TSCG).(2)The operative effect was compared using the American Orthopedic Society for Foot and Ankle(AOFAS)forefoot score.visual analog scale(VAS)score,and postoperative complications.Results Thirty-nine patients(48 feet)were followed up for 6-24(10.6+3.6)months.All the patients'wounds healed in stage I without infection or recurrence.No significant difference was found in the baseline data of age,body mass index(BMI),follow-up time,side,sex,type,complications,and combined operation between the modified and traditional Scarf groups(all P values>0.05).Preoperative HVA,IMA,DMAA,TSCG,andαangle were not significantly different between the two groups(all P values>0.05).At the last follow-up,the difference between postoperative DMAA and preoperative DMAA was not significant in the traditional Scarf gr

关 键 词：拇外翻 Scarf截骨术 第1跖骨旋转 跖骨远端关节面角 

分 类 号：R687.3[医药卫生—骨科学]