微钢板超编织线悬吊固定第1、2跖骨治疗[足母]外翻

Suspension fixation between 1st and 2nd metatarsals with mini plates and ultrabraid suture for mild and moderate hallux valgus

[目的]介绍采用第1、2跖骨间Endobutton微钢板结合超编织线悬吊固定治疗[足母]外翻的手术技术,并评价其治疗效果。[方法]2014年1月~2018年1月采用Endobutton微钢板结合超编织线悬吊固定疗[足母]外翻15例(24足)。于第一跖趾关节内侧作一长约4 cm切口,显露第1跖骨头外侧增生骨与软组织并将其切除,修剪增生的关节囊。暴露第2跖骨外侧面,并收紧第1、2跖骨,以1.1 mm钻头由第1跖骨内侧向第2跖骨处钻孔,1根超编织缝线穿入第1枚Endobunon微钢板的第2、3孔置于第1跖骨内侧面,钢丝导入骨隧道,带出超编织缝线至第2跖骨外侧面,将超编织缝线穿入第2枚Endobutton微钢板穿入第2、3孔并打结缝线锁定。[结果]随访时间6~36个月,手术前与术后12个月比较,AOFAS评分[(62.13±6.64)vs(89.27±7.39),P<0.05],[足母]外翻角[(28.44±4.73)°vs(14.80±3.47)°,P<0.05],第1、2跖骨间角[(17.24±4.85)°vs(9.99±3.56)°,P<0.05]均显著改善,差异有统计学意义。[结论]微钢板结合超编织线悬吊固定治疗[足母]外翻是一种简单、有效、创伤性小的手术方法,无需截骨,对轻、中度[足母]外翻畸形有较好的治疗效果。

[Objective]To introduce the surgical technique and primary clinical outcomes of suspension fixation between the first and second metatarsals with mini plates and ultrabraid suture for hallux valgus.[Methods]From January 2014 to January 2018,15 patients(24 feet)underwent suspension fixation between the first and second metatarsals with mini plates and ultrabraid suture for hallux valgus.A incision length in 4 cm was made on medial side of the first metatarsal to expose osteophytes and hypertrophic soft tissue and remove them.The hallux adductor tendon and metatarsal transvers ligament were cut off,and the lateral capsule of first metatarsophalangeal joint was released.The first and second metatarsals were closed each other by force,and a bone tunnel from medial side of the first metatarsal to the lateral side of the second metatarsal was created by a drill with 1.1 mm in diameter.After that,the ultrabraid sutures were introduced through the bone tunnel and the holes on the mini plates both sides,and tighten and tied.[Results]All the patients were followed up for 6-36 months.Compared the parameters before operation with those at 12 months postoperatively,significant improvements were proved in AOFAS score[(62.13±6.64)versus(89.27±7.39),P<0.05],the hallux valgus angle[(28.44±4.73)°versus(14.80±3.47)°,P<0.05],and angle between the first and second metatarsals[(17.24±4.85)°vs(9.99±3.56)°,P<0.05],which all were statistically significant.[Conclusion]This suspension fixation between the first and second metatarsals with mini-plates and ultrabraid suture for hallux valgus is a simple,effective and minimally invasive surgical method without osteotomy,which achieves good therapeutic outcomes for mild and moderate hallux valgus deformity.