微创截骨治疗[足母]外翻的远期疗效分析

Long-term efficacy analysis of minimal incision osteotomy for treatment of hallux valgus

目的 评价微创截骨治疗[足母]外翻的远期疗效.方法 对1996年2月至1999年5月在我院行微创截骨治疗的[足母]外翻患者进行回顾性分析,共79例（150足）获得5年以上随访,男6例（10足）,女73例（140足）;年龄13～75岁,平均47岁.术后随访5.3～13.2年,平均7.5年.观察手术前、后（足母）外翻角（hallux valgus angles,HVA）,第一、二跖骨间角（intermetatarsal angles,IMA）,胫侧籽骨位置（tibial sesamoid bone position,TSP）,[足母]趾-跖趾-趾间关节美国足与踝关节协会（American orthopedic foot and ankle society,AOFAS）评分,第一跖趾关节活动度和第二、三跖骨头下胼胝体（肼胝痛）等指标.根据温建民等的临床疗效评价标准（2001年）对临床疗效进行评价.结果 临床疗效评价优56足,占37.3%;良88足,占58.7%;差6足,占4.0%;优良率为96.0%（144/150）.术后AOFAS评分为60～100分,平均（84.20±4.32）分.HVA较术前矫正20.97°;IMA较术前矫正4.95°;TSP较术前矫正1.22;第一跖趾关节活动度减少0.67°.术前合并有跖骨头下疼痛97足,占64.7%.术后疼痛消失35足（23.3%）,疼痛改善54足（36.0%）,疼痛无改善（或加重）8足（5.3%）.结论 微创截骨治疗[足母]外翻方法简单、并发症少、远期疗效肯定,是治疗[足母]外翻的一种较好的、疗效可靠的手术方法.

Objective To evaluate the long-term results of minimal incision osteotomy for hallux valgus.Methods From February 1996 to May 1999,372 cases（705 feet）with hallux valgus were treated with minimal incision osteotomy.Seventy-nine cases after surgery were followed up for more than 5 years,including 6 males（10 feet）and 73 females（140 feet）with an average age of 47 years（range,13-75 years）.The average follow-up time was 7.5 years（range,5.3-13.2 years）.The preoperative and postoperative hallux valgus angles（HVA）,intermetatarsal angles（IMA）,the tibial sesamoid position（TSP）,American orthopedic foot and ankle society（AOFAS）score,range of movement of the first metatarsophalangeal joint,and lateral metatarsalgia etc.were observed and measured.And the clinic outcome were studied and evaluated.Results Based on Wen Jian-min＇s clinic curative effect evaluation criterion（2001）,56 feet（37.3%）were excellent,88 feet（58.7%）good ,6 feet（4.0%）fair.The rate of excellent or good was 96.0%（144/150）.The postoperative mean AOFAS score was 84.20±4.32 points（range,60-100 points）.The mean HVA decreased from 33.28 to 12.31 degrees,the mean IMA from 11.75 to 6.80 degrees.The TSP was corrected from an average preoperative grade of 4.29 to a grade of 3.07 at final follow-up.There are no nonunion or delayed union of osteotomy,avascular necrosis of the 1st metatarsal head,infection,hallux varus.Four feet（2.7%）had numbness in the medial of the big toe.The 1st metatarsophalangeal joint range of motion decreased from 70.20 to 69.53 degrees.There were 97 feet（64.7%）with the 2-5 metatarsalgia before operation,and 35 feet（23.3%）disappeared,54 feet（36.0%）improved,8 feet（5.3%）aggravated after operation.Conclusion Minimal incision osteotomy technique is sound and reliable method to treat hallux valgus.The osteotomy technique is simple,and could provide satisfactory long-term results with lower complication rate.