小切口关节外微创截骨术后[足母]外翻前足宽度变化的比较研究  

Comparative study on changes in forefoot width after minimally invasive extra-articular osteotomy via small incision for hallux valgus

作　　者：张洋 袁艳荣[1] 孔德海[1] 刘颖[1] 孙广超[1] ZHANG Yang;YUAN Yanrong;KONG Dehai;LIU Ying;SUN Guangchao(Department of Foot and Ankle Surgery,Binzhou Medical University Hospital,Binzhou Shandong,256603,P.R.China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603

出　　处：《中国修复重建外科杂志》2025年第2期140-145,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：山东省医药卫生科技发展计划项目(202104070986)。

摘　　要：目的比较小切口关节外微创截骨术与传统Chevron截骨术后[足母]外翻前足宽度差异。方法回顾分析2019年4月—2022年7月收治且符合选择标准的45例[足母]外翻患者临床资料,其中接受传统Chevron截骨术23例(传统组)、小切口关节外微创截骨术22例(微创组)。两组患者性别、年龄、侧别、[足母]外翻Mann分型、病程以及术前第1、2跖骨间角(intermetatarsal angle,IMA)、[足母]外翻角(hallux valgus angle,HVA)、跖骨远端关节面角(distal metatarsal articular angle,DMAA)、骨性前足宽度、软组织前足宽度、骨赘宽度、美国矫形足踝协会(AOFAS)评分等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者术后截骨愈合时间及并发症发生情况,各影像学指标和术后12个月AOFAS评分与术前差值(变化值),以及术后1、6、12个月前足骨性及软组织宽度。结果微创组术中1例出现皮肤损伤,传统组术后3例出现切口愈合不良,均无感染、神经损伤等并发症发生。两组患者术后均获随访,随访时间12~31个月,平均22.5个月。两组截骨均愈合且愈合时间差异无统计学意义(P>0.05)。两组术后12个月IMA、HVA、DMAA、骨赘宽度及AOFAS评分与术前比较,差异均有统计学意义(P<0.05);两组间IMA变化值、HVA变化值及骨赘宽度变化值差异无统计学意义(P>0.05),微创组AOFAS评分变化值及DMAA变化值优于对照组,差异有统计学意义(P<0.05)。两组间术后各时间点骨性前足宽度及软组织前足宽度比较,差异均无统计学意义(P>0.05);组内术后各时间点与术前比较,差异均有统计学意义(P<0.05)。结论小切口关节外微创截骨术治疗[足母]外翻,虽未清理第1跖骨内侧骨赘,仍可以有效改善患者前足宽度及骨赘宽度,在纠正IMA、HVA的同时更有效恢复DMAA,获得更好的AOFAS评分。Objective To compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus.Methods A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022.Among them,22 cases underwent minimally invasive extra-articular osteotomy via small incision(minimally invasive group),and 23 cases underwent traditional Chevron osteotomy(traditional group).There was no significant difference in the baseline data between the two groups(P>0.05),including gender,age,affected side,Mann classification of hallux valgus,disease duration,and preoperative intermetatarsal angle(IMA),hallux valgus angle(HVA),distal metatarsal articular angle(DMAA),bony forefoot width,soft tissue forefoot width,osteophyte width,and American Orthopaedic Foot and Ankle Society(AOFAS)score.The osteotomy healing time and the occurrence of complications in the two groups were recorded.The differences between pre-and post-operation(changes)in various imaging indicators and AOFAS scores in the two groups were calculated.And the bony forefoot width and soft tissue forefoot width at 1,6,and 12 months after operation were also recorded and compared between the two groups.Results One case of skin injury occurred during operation in the minimally invasive group,while 3 cases of poor wound healing occurred after operation in the traditional group.None of the patients experienced infections,nerve injuries,or other complications.All patients were followed up 12-31 months(mean,22.5 months).The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found(P>0.05).The IMA,HVA,DMAA,osteophyte width,and AOFAS score at 12 months after operation significantly improved compared to those before operation(P<0.05).There was no significant difference between the two groups in the changes of IMA,HVA,and osteophyte width(P>0.05).However,the differences in the

关 键 词：[足母]外翻 前足宽度 关节外截骨 Chevron截骨 

分 类 号：R687.3[医药卫生—骨科学]