青少年足母外翻截骨矫形术中两种固定方法效果的比较

Comparison of Two Different Fixation in Adolescent Hallux Valgus Osteotomy

目的通过对青少年足母外翻应用第1跖骨截骨矫形治疗术后分别应用克氏针与接骨板两种方法固定截骨端的方式进行比较,分析两种固定方法的效果。方法回顾性研究2008年1月至2014年7月期间收治的青少年足母外翻患者23例（40足）,根据内固定方式不同将获得随访的患者分为克氏针固定组（A组）和接骨板固定组（B组）。每足术前及术后、末次随访时均拍摄足负重正侧位X线片,测量足母外翻角（hallux valgus angle,HVA）和1~2跖骨间角（inter metatarsal angle,IMA）;根据AOFAS足母趾、跖趾关节、趾间关节评分进行功能评估,并记录并发症发生情况。比较术前及术后、末次随访时HVA和1~2 IMA及美国矫形外科足踝协会（American orthopaedic foot and ankle society,AOFAS）评分评估患者功能预后,选择SPSS 19.0进行数据统计分析。结果统计分析表明：克氏针组与接骨板组术前HVA、IMA、AOFAS评分差异无统计学意义（P〉0.05）,术后1 d二者HVA、IMA差异无统计学意义（P〉0.05）;术后1年,克氏针组与接骨板组HVA、IMA、AOFAS评分差异均有统计学意义（P〈0.05）。结论应用克氏针内固定和应用接骨板内固定的两组患者,在术后短期内效果差异无统计学意义,术后1年差异有统计学意义,第1跖骨截骨端应用接骨板内固定效果要优于应用克氏针内固定。

Objective To compare the fixation effects of Kirschner and bone plate in metatarsal osteotomy in adolescent hallux valgus. Methods There were 23 adolescent hallux valgus patients（ 40 feet）. The cases were divided into group A and group B by different internal fixation methods. Group A were fixed with Kirschner wire,group B were fixed with plate. We took weight-bearring foot anteroposterior and lateral X-ray film before and after operation and in the last follow-up. We also measured the HVA and 1 ~ 2 IMA,assessed the function by the AOFAS hallux metatarsophalangeal joint,interphalangeal joint score,and recorded concurrently disease occurrence,assessed the patient final follow-up function by comparing the hallux valgus angle（ HVA） and 1 ~ 2 metatarsal angle（ IMA） and AOFAS score in preoperative exam,postoperative exam and final follow-up. SPSS 19. 0 was used to do the statistics. Results Statistical analysis showed that there was no significantly different in the Kirschner wire group and the plate group in HVA（ P = 0. 565）,IMA（ P = 0. 911） and AOFAS（ P = 0. 818）. And in both groups＇ HVA（ P = 0. 737）,IMA（ P = 0. 453） had no significantly different one day after operation. The Kirschner group and the plate group HVA（P〈0. 05）,IMA（P〈0. 051） and AOFAS（P〈0. 05） were significantly different one year after the operation. Conclusion The Kirschner group and the plate group are not significantly different in a short term after the operation,but significantly different after one year. That means the plate is better than Kirschner wire.