拇外翻畸形截骨矫形后第一跖骨三维层面畸形指标的量化分析  

Quantitative analysis of three-dimensional deformity indexes of the first metatarsal bone after osteotomy and orthosis for hallux valgus deformity

作　　者：赵晓亮 孙梅兰 闫天元 张世喆 牛国昌 关玉龙 李华 Zhao Xiaoliang;Sun Meilan;Yan Tianyuan;Zhang Shizhe;Niu Guochang;Guan Yulong;Li Hua(Department of Hand and Foot Surgery,Hengshui People’s Hospital,Hengshui 053000,Hebei Province,China;Department of Surgery,Hengshui Third People’s Hospital,Hengshui 053000,Hebei Province,China)

机构地区：[1]衡水市人民医院手足外科,河北省衡水市053000 [2]衡水市第三人民医院外科,河北省衡水市053000

出　　处：《中国组织工程研究》2024年第33期5302-5307,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省2023年度医学科学研究课题(20232186),项目名称:拇外翻第一跖骨病理变化特点及其与术后疗效相关性分析,项目负责人:赵晓亮。

摘　　要：背景:关于拇外翻畸形二维层面的第一跖骨骨性结构位移改变参数对临床诊疗有重要意义,而三维层面畸形指标量化分析可能对术后疗效有一定影响。目的:探讨拇外翻畸形截骨矫形术后第一跖骨三维层面畸形指标量化改变,为临床工作提供参考。方法:选择2020年10月至2023年4月衡水市人民医院收治的拇外翻畸形患者100例(足),均行截骨矫形术。于术后6个月采用美国足踝矫形学会拇趾关节评分评估患者足部功能;术前、术后6个月拍摄负重位足部正侧位X射线片及模拟负重位CT片,量化分析不同年龄、不同性别、不同疗效患者手术前后第一跖骨三维层面畸形指标,包括第1-2跖骨间角、拇外翻角、远端关节面固角、胫侧籽骨位置及第一跖骨旋转α角,分析第一跖骨三维层面畸形指标手术前后差值对疗效的评估价值。结果与结论:①术后6个月美国足踝矫形学会评分为75-98分,平均(88.25±4.14)分,其中优56例,良28例,可14例,差2例,优良率为84%(84/100);②相较于术前,不同年龄、不同性别拇外翻畸形患者术后6个月第1-2跖骨间角、拇外翻角、远端关节面固角、胫侧籽骨位置及第一跖骨旋转α角均明显改善(P<0.05);疗效良好患者术后6个月第1-2跖骨间角、拇外翻角、远端关节面固角、胫侧籽骨位置及第一跖骨旋转α角均低于疗效不良患者,且手术前后差值大于疗效不良患者(P<0.05);③第一跖骨三维层面畸形指标手术前后差值评估曲线下面积值均在0.7以上,且各指标联合评估曲线下面积值最大,为0.902,明显大于第一跖骨旋转α角及远端关节面固角(P<0.05);④提示拇外翻畸形患者第一跖骨三维层面畸形指标的内在关系与术后疗效有关,对提升术前评估的准确全面性、改进治疗方案有重要指导意义。BACKGROUND:The displacement change parameters of the bone structure of the first metatarsal bone at the two-dimensional level of hallux valgus deformity are of great significance for clinical diagnosis and treatment,while the quantitative analysis of the three-dimensional deformity index may have some influences on the postoperative efficacy.OBJECTIVE:To explore the quantitative change of the three-dimensional deformity index of the first metatarsal bone after routine osteotomy and orthosis for hallux valgus deformity and to provide reference for clinical work.METHODS:100 patients with hallux valgus deformity(foot)in Hengshui People’s Hospital from October 2020 to April 2023 were selected and all of them underwent conventional osteotomy and orthosis.Foot function was assessed by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale 6 months after surgery.Anterolateral X-rays of the foot in weight-bearing position and CT images in simulated weight-bearing position were taken before surgery and 6 months after surgery.The three-dimensional deformity indexes of the first metatarsal bone before and after surgery were quantitatively analyzed in patients with different ages,genders and therapeutic effects,including first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotationαangle.The value of the difference of three-dimensional deformity indexes of the first metatarsal bone before and after operation in evaluating the curative effect was analyzed.RESULTS AND CONCLUSION:(1)Six months after operation,the American Orthopedic Foot and Ankle Society score was 75-98(88.25±4.14)points,among which 56 cases were excellent,28 cases were good,14 cases were average,and 2 cases were poor.The excellent and good rate was 84%(84/100).(2)Compared with the preoperative results,first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotationαangle were signifi

关 键 词：截骨矫形术 拇外翻畸形 美国足踝矫形学会评分 第1-2跖骨间角 拇外翻角 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687