不同关节面处理方式对Lapidus手术治疗拇外翻的疗效对比研究  

A comparative study of Lapidus procedure with different articular surface preparation techniques in the treatment of hallux valgus

作　　者：解冰 韩天宇 田竞 Xie Bing;Han Tianyu;Tian Jing(Department of Orthopedics,Northern Theater General Hospital,Shenyang Liaoning,110016,China)

机构地区：[1]中国人民解放军北部战区总医院骨科,辽宁沈阳110016

出　　处：《生物骨科材料与临床研究》2024年第5期54-58,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 比较在Lapidus手术治疗拇外翻中不同跖楔关节面处理方式对患者术后临床疗效的差异。方法 回顾分析2009年1月至2019年1月中国人民解放军北部战区总医院收治的33例采用Lapidus手术治疗的拇外翻患者的临床资料。固定方式均为钢板固定,根据跖楔关节面处理方式不同分为A组(18例,关节面楔形骨块切除)和B组(15例,单纯去除关节面软骨)。比较两组围术期切口并发症(感染、裂开或坏死)、骨愈合情况、拇外翻角(hallux valgus angle, HVA),第1、2跖骨间角(1st and 2nd intermetatarsal angle, IMA),第1跖骨短缩情况及术后并发症,并采用美国足踝外科协会(American Orthopedic Foot and Ankle Society, AOFAS)前足功能评分评价临床疗效。结果 两组患者均完成术后随访,随访时间12~36个月,平均(22.9±9.2)个月。A组术后有1例切口皮缘坏死,有2例出现转移性跖骨痛;B组术后1例切口裂开,有1例出现内固定刺激;两组围术期并发症比较,差异无统计学意义(P>0.05)。两组均获一期骨愈合,A组术后12周时均已骨愈合,B组术后12周时有14例已骨愈合,有1例骨延迟愈合(14周)。A组HVA和IMA分别由手术前(36.1±10.2)°和(16.9±5.3)°降低至术后1年的(17.2±5.9)°和(5.6±1.4)°;B组HVA和IMA分别由手术前(37.2±11.4)°和(17.3±7.7)°降低至术后1年的(16.2±7.4)°和(6.9±2.2)°。两组间术后1年的HVA和IMA比较,差异无统计学意义(P>0.05)。A组术后1年的第1跖骨短缩为(6.8±2.3)mm,B组为(2.6±1.1)mm,差异有统计学意义(P<0.05)。两组术后1年的AOFAS评分比较,差异无统计学意义(P>0.05)。结论 对于采用Lapidus手术治疗的拇外翻患者,两种关节面处理方式均可获得较好的骨愈合率及满意的临床疗效。相比传统关节面楔形骨块切除,单纯去除关节面软骨可以有效保留第1跖骨长度。Objective To compare the clinical effect of different articular surface preparation techniques in the treatment of hallux valgus with the Lapidus procedure.Methods The clinical data of 33 patients with hallux valgus treated with the Lapidus procedure at the Northern Theatre General Hospital from January 2009 to January 2019 were analysed.They were all fixed with a plate and divided into group A(18 cases,articular wedge resection)and group B(15 cases,articular cartilage surface resection)according to the articular surface preparation techniques.Incision complications(infection,dehiscence or necrosis),bone healing time,hallux valgus angle(HVA),1st and 2nd intermetatarsal angle(IMA),first metatarsal length changes and postoperative complications were compared between the two groups.Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society(AOFAS)forefoot scale.Results Both groups completed the postoperative follow-up,with a follow-up time of 12-36 months,an average of(22.9±9.2)months.There were 1 case of incision margin necrosis and 2 cases of postoperative complications(metatarsalgia)occurred in group A,1 case of incision dehiscence and 1 case of plate irritation occurred in group B,no significant difference of postoperative complication was noticed between the two groups(P>0.05).Primary bone union was achieved in all patients.In group A,all patients achieved bone healing at 12 weeks.While in group B,14 patients achieved bone healing at 12 weeks,1 patient achieved delayed bone healing at 14 weeks.In group A,HVA and IMA were reduced from(36.1±10.2)°and(16.9±5.3)°preoperatively to(17.2±5.9)°and(5.6±1.4)°at one year after the surgery.In group B,HVA and IMA were reduced from(37.2±11.4)°and(17.3±7.7)°preoperatively to(16.2±7.4)°and(6.9±2.2)°at one year after the surgery.There were no significant differences in HVA and IMA at one year after surgery between the two groups(P>0.05).The mean amount of first metatarsal length shortening was(6.8±2.3)mm in group A and(2.6±1.1)mm in gr

关 键 词：拇外翻 Lapidus手术 跖楔关节 关节融合术 

分 类 号：R682.6[医药卫生—骨科学]