第一跖骨横行截骨克氏针固定治疗轻中度[母]外翻的早期临床疗效  

Short-term efficacy of transverse osteotomy of the first metatarsal and fixation with two Kirschner wires for mild to moderate hallux valgus

作　　者：申琳[1] 蒋宁 王佳[1] 曾宪铁 Shen Lin;Jiang Ning;Wang Jia;Zeng Xiantie(Foot and Ankle Ward Two,Tianjin Hospital,Tianjin University,Tianjin 300211,China;Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津大学天津医院足踝二病区,天津300211 [2]天津中医药大学研究生院,天津301617

出　　处：《中华骨科杂志》2025年第3期144-150,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨第一跖骨横行截骨克氏针固定治疗轻中度[母]外翻的短期疗效。方法回顾性分析2022年3月至2023年6月在天津大学天津医院接受手术治疗的44例(55足)[母]外翻患者资料,根据手术方法分为横行截骨组(第一跖骨横行截骨克氏针固定)和Scarf截骨组(第一跖骨"Z"形截骨螺钉固定)。横行截骨组20例(25足),均为女性,年龄(54.56±3.13)岁(范围50~62岁),左12足、右13足,轻度外翻7足、中度外翻18足。Scarf截骨组24例(30足),男3例、女21例,年龄(52.43±5.46)岁(范围39~60岁),左15足、右15足,轻度外翻3足、中度外翻27足。比较两组患者的手术时间、术前和末次随访时的外翻角(hallux valgus angle,HVA)、第一、二跖骨间角(intermetatarsal angle,IMA)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)前足评分、疼痛视觉模拟评分(visual analogue scale,VAS)以及术后并发症情况。结果两组患者均获得随访,随访时间(13.28±4.42)个月(范围6~18个月)。横行截骨组手术时间为(28.96±4.10)min,较Scarf截骨组(45.37±4.72)min短,差异有统计学意义(t=13.612,P<0.001)。横行截骨组术前HVA和IMA分别为32.48°±3.9°和14.53°±1.89°,末次随访时分别为8.59°±3.06°和5.07°±1.74°,手术前后差异均有统计学意义(P<0.05)。Scarf截骨组术前HVA和IMA分别为32.83°±2.33°和13.7°±2.03°,末次随访时分别为9.87°±2.66°和5.73°±1.74°,手术前后差异均有统计学意义(P<0.05);术前和末次随访时两组HVA和IMA的差异均无统计学意义(P>0.05)。横行截骨组术前VAS和AOFAS评分分别为6.0(5.5,7.0)分和(48.40±6.04)分,末次随访时分别为2.0(1.0,2.0)分和(87.36±5.02),手术前后比较差异均有统计学意义(P<0.05)。Scarf截骨组术前VAS和AOFAS评分分别为6.0(5.0,6.0)分和(50.70±7.31)分,末次随访时分别为2.0(2.0,2.0)分和(84.43±3.45)分,手术前后比较差异均有统计学意义(P<0.05);手术前后VAS评分和术前AOFAS评分Objective To investigate the short-term efficacy of transverse osteotomy of the first metatarsal and fixation with Kirschner wires for mild to moderate hallux valgus(HV).MethodsThis was a retrospective cohort study.A total of 44 patients(55 feet)with HV who underwent surgical treatment in the Foot and Ankle Ward Two,Tianjin Hospital,Tianjin University from March 2022 to June 2023 were enrolled,including 41 females and 3 males.Based on the different surgical methods,they were divided into a transverse osteotomy group and Scarf group.The transverse osteotomy group was treated with transverse osteotomy of the first metatarsal and fixation with two Kirschner wires,and the Scarf group was treated with"Z"osteotomy and screw fixation.The transverse osteotomy group consisted of 20 patients(25 feet),all female,with an average age of 54.56±3.13 years(range,50-62 years),including 12 left feet and 13 right feet.Among them,7 feet had mild HV,and 18 feet had moderate HV.The Scarf osteotomy group included 24 patients(30 feet),3 males and 21 females,with an average age of 52.43±5.46 years(range,39-60 years),including 15 left feet and 15 right feet.Among them,3 feet had mild HV and 27 feet had moderate HV.Observation indicators:(1)The imaging indicators of the two groups were compared before operation and at the last follow-up.These indicators included hallux valgus angle(HVA),intermetatarsal angle(IMA).(2)The clinical efficacy of the two groups was compared,including American Orthopaedic Foot and Ankle Society(AOFAS)forefoot score and visual analogue scale(VAS),as well as postoperative complications.(3)The operation time of the two groups was recorded respectively.ResultsBoth groups were followed up for an average duration of 6-18 months(13.28±4.42 months).There were no significant differences in preoperative baseline characteristics between the transverse osteotomy group and the Scarf group(P>0.05).The mean operation time was 28.96±4.10 min for the transverse osteotomy group and 45.37±4.72 min for the Scarf group,with a st

关 键 词：[母]外翻 截骨术 克氏针 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]