应用超声骨刀微创囊外截骨治疗中重度拇外翻的疗效分析  

Analysis of the therapeutic effect of minimally invasive extra-articular osteotomy with ultrasonic osteotome in the treatment of moderate and severe hallux valgus

作　　者：袁罕 陈国梁 徐明亮 石荣剑 魏笛 YUAN Han;CHEN Guoliang;XU Mingliang;SHI Rongjian;WEI Di(Department of Foot and Ankle Surgery,Xuzhou Renci Hospital,Xuzhou 221000,China)

机构地区：[1]徐州仁慈医院足踝外科,江苏徐州221000

出　　处：《中国美容整形外科杂志》2025年第3期167-171,共5页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：徐州市重点研发计划(社会发展)项目-医药卫生面上项目(20220621)。

摘　　要：目的 探讨应用超声骨刀微创囊外截骨治疗中重度拇外翻的临床效果。方法 回顾性分析自2022年1月至2024年1月,徐州仁慈医院足踝外科收治的19例(23足)中重度拇外翻患者的临床资料,采用超声骨刀囊外微创截骨矫正拇外翻。术前及术后6个月行足负重正侧位片检查,测量记录拇外翻角(hallux valgus angle,HVA)、第1、2跖骨间角(intermetatarsal angel, IMA)、跖趾关节远端固定角(distal articular set angle, DASA)、跖骨远端关节角或关节近端固有角(proximal articular set angle,PASA;distal metatarsal articular angle,DMAA)角度及第一跖骨长度并进行对比。记录术前及术后6个月第一跖趾关节活动度、美国足踝外科学会前足功能评分(American Orthopedic Foot and Ankle Society,AOFAS)、视觉疼痛模拟评分(visual analogue scales, VAS)并进行对比。结果 19例患者均随访10~14个月,跖骨骨愈合时间为(3.0±1.2)个月。术后拇外翻畸形均得到矫正,未出现拇内翻、截骨不愈合、皮肤坏死等并发症。术后6个月,HVA、IMA、DASA、PASA(DMAA)、AOFAS、VAS与术前比较,差异有统计学意义(P<0.05);第一跖趾关节活动度及第1跖骨长度术前与术后6个月比较,差异无统计学意义(P>0.05)。4例患者重度拇外翻联合Akin(近节趾骨内侧楔形截骨术),1例术后麻木,1例术后转移性跖骨痛。结论 应用超声骨刀囊外微创截骨治疗中重度拇外翻具有创伤较小、恢复较快、外形较佳、疗效明显等优点。Objective To investigate the clinical effect of minimally invasive extracapsular osteotomy with ultrasonic bone knife in the treatment of moderate and severe hallux valgus. Methods A retrospective analysis was performed on 19 patients(23 feet) with moderate or severe bunions admitted to the Foot and Ankle Surgery Department of Xuzhou Renyi Hospital from January 2022 to January2024. All of them were corrected by minimally invasive ultrasonic bone knife exocyst osteotomy. Before surgery and at the last follow-up,the anterior-lateral film of foot weight was performed. HVA(hallus valgus Angle), IMA(intermetatarsal Angle), DASA(distal articular set angle), PASA(DMAA) [proximal articular set angle(distal metatarsal articular angle)] and the length of first metatarsal bone were measured and compared. First metatarsophalangeal joint motion, American Orthopedic Foot and Ankle Society(AOFAS) forefoot function score and visual pain analog scale(VAS) were recorded and compared before and at the postoperative 6 months. Results All patients were followed up for 10 to 14 months and the healing time of metatarsal bone was(3.0±1.2) months. The deformity of hallux valgus was corrected after operation, and no complications such as hallux varus, nonunion of osteotomy and skin necrosis occurred. At the postoperative 6 months,HVA, IMA, DASA, PASA(DMAA), AOFAS and VAS were statistically significant compared with those before surgery(P<0.05). There was no significant difference between the first metatarsophalangeal joint motion and the length of the first metatarsal bone before and at the postoperative 6 months(P>0.05). In 4 patients with severe bunion valgus combined with Akin(medial wedge osteotomy of proximal phalanges), 1 patient had postoperative numbness and 1 patient had postoperative metastatic metatarsal pain. Conclusion The treatment of moderate and severe bunion valgus with minimally invasive ultrasonic bone knife extracapsulary osteotomy has the advantages of less trauma, quick recovery, good appearance and obvious curative

关 键 词：超声骨刀 拇外翻 微创 关节囊 重度 跖骨颈 

分 类 号：R687.3[医药卫生—骨科学]