第1跖骨近端新月形截骨克氏针内固定联合软组织松解治疗中重度外翻疗效观察

Effect of correcting the moderate and severe hallux valgus by using the proximal crescentic metatarsal osteotomy with K-wire fixation and soft tissue release

目的探讨第1跖骨近端新月形截骨克氏针内固定联合软组织松解治疗中重度外翻的疗效。方法 2005年6月至2013年6月采用第1跖骨近端新月形截骨克氏针内固定联合软组织松解治疗中重度外翻病例41例(44足),获随访27例(30足)。术后通过影像学检查与术前比较评估外翻角(HVA)和跖骨间角(IMA)的变化,通过AOFAS、VAS评分评估临床功能。结果获随访的27例(30足)在影像学评估和临床功能评分方面较术前明显改善,具有显著的统计学差异(P<0.001)。结论选择合适病例进行第1跖骨近端新月形截骨克氏针内固定联合软组织松解术可以取得满意疗效,具有操作简单、矫正效果可靠、费用低廉的优点,尤其适合在基层医院开展。

Objective To study the effect of correcting the moderate and severe hallux valgus by using the proximal crescentic metatarsal osteotomy with K-wire fixation and soft tissue release. Method From June 2005 to June 2013, 41 patients（44 feet） with the moderate or severe hallux valgus were treated by crescentic osteotomy at the proximal end of the first metatarsal plus K-wire fixation in combination with the soft tissue release. Twenty-seven patients（30 feet） were included during the follow-up. The hallux valgus angle（HVA） and intermetatarsal angle（IMA） were evaluated before and after operation for comparing their changes. The scoring method of American Orthopaedic Foot and Ankle Society（AOFAS） and Visual Analogue Scale（VAS） were used to evaluate the foot functions. Result Both of the post-operative imaging result and the functional scores were significantly improved in 27 patients（30 feet） with a statistical difference（P〈0.001）. Conclusion The crescentic osteotomy at the proximal end of the first metatarsal plus K-wire fixation in combination with the soft tissue release can correct the hallux valgus with a satisfactory effect. It is convenient, reliable and inexpensive, which could be practiced in the advancing hospitals.