第四代微创技术治疗[母]外翻的疗效  

Clinical application strategy of the fourth generation minimally invasive surgery for hallux valgus

作　　者：邹崟 李立 芦浩[1] 李贵成 杜成博 徐海林[1] Zou Yin;Li Li;Lu Hao;Li Guicheng;Du Chengbo;Xu Hailin(Department of Traumatic Orthopaedics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院创伤骨科,北京100044

出　　处：《中华骨科杂志》2025年第3期166-171,共6页Chinese Journal of Orthopaedics

基　　金：北京市自然科学基金(L234015)。

摘　　要：目的探讨采用第四代微创技术治疗[母]外翻的临床效果。方法回顾性分析2019年10月至2023年3月于北京大学人民医院行第四代微创技术治疗26例(42足)[母]外翻的患者资料,男5例(9足)、女21例(33足),年龄(49.9±15.1)岁(范围19~75岁)。通过微创跖骨远端关节外横行截骨联合Akin截骨、单枚全螺纹螺钉固定及截骨后外侧软组织松解对外翻畸形进行矫正。于术前及末次随访时测量外翻角(hallux valgus angle,HVA)、跖骨间角(intermetatarsal angle,IMA),采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分系统和疼痛视觉模拟评分(visual analogue scale,VAS)进行疗效评价。结果26例(42足)均顺利完成手术并获得随访,随访时间(9.6±5.2)个月(范围6~30个月)。42足手术时间为(69.1±16.2)min(范围30~105 min),术中出血量为(10.0±7.4)ml(范围1~30 ml)。所有患者术中无主要血管、神经、肌腱损伤等严重并发症发生。随访过程中1足因术后未及时行功能锻炼发生第一跖趾关节僵硬。未出现复发、延迟愈合、不愈合等其他并发症。至末次随访1例(2足)因患者要求而行内固定取出。末次随访时42足的HVA由术前29.5°±7.4°降低至9.2°±4.6°、IMA由术前11.9°±3.8°降低至5.0°±3.6°、AOFAS评分由术前(56.6±10.2)分升高至(91.7±6.8)分,VAS由术前(5.2±2.3)分降低至(0.9±1.1)分,差异均有统计学意义(P<0.05)。结论以微创横行截骨、单枚全螺纹螺钉固定、截骨后外侧软组织松解联合Akin截骨为特点的第四代[母]外翻微创技术简单安全有效、易于操作,能获得良好的早期疗效,并发症较少。Objective To explore the clinical efficacy of the fourth-generation minimally invasive surgery(MIS)for the treatment of hallux valgus.MethodsA retrospective analysis was conducted on 26 patients(42 feet)who underwent fourth-generation MIS for hallux valgus at Peking University People's Hospital from October 2019 to March 2023.The patients included 5 males(9 feet)and 21 females(33 feet),with an average age of 49.9±15.1 years(range 19-75 years).The hallux valgus deformity was corrected through minimally invasive extra-articular transverse osteotomy of the distal metatarsal combined with Akin osteotomy,fixation with a single fully threaded screw,and lateral soft tissue release after osteotomy.The hallux valgus angle(HVA)and intermetatarsal angle(IMA)were measured before surgery and at the final follow-up.The American Orthopaedic Foot and Ankle Society(AOFAS)scoring system and the visual analogue scale(VAS)were used to evaluate the treatment efficacy.ResultsAll 26 patients(42 feet)were followed up for a mean duration of 9.6±5.2 months(range 6-30 months).All 42 feet successfully underwent surgery,with an average operation time of 69.1±16.2 minutes(range 30-105 minutes)and an average blood loss of 10.0±7.4 ml(range 1-30 ml).No serious complications such as major vessel,nerve,or tendon damage occurred during the surgery for any patient.During the follow-up,one foot developed stiffness in the first metatarsophalangeal joint due to a lack of timely functional exercise after surgery.No other complications such as recurrence,delayed union,or nonunion were observed.By the final follow-up,one patient(2 feet)requested removal of the internal fixation.The HVA before surgery and at the final follow-up was 29.5±7.4 and 9.2±4.6,respectively,while the IMA was 11.9±3.8 and 5.0±3.6.The AOFAS score improved from 56.6±10.2 to 91.7±6.8,and the VAS score decreased from 5.2±2.3 to 0.9±1.1,all with significant differences(P<0.05).ConclusionThe fourth-generation minimally invasive surgery for hallux valgus,characterized by minim

关 键 词：[母]外翻 最小侵入性外科手术 截骨术 软组织松解 

分 类 号：R687.3[医药卫生—骨科学]