第一跖骨基底部闭合楔形截骨结合锁定钢板治疗中重度外翻

Proximal closing wedge metatarsal osteotomy combined with locking plate fixation in treatment of moderate and severe hallux valgus deformity

[目的]探讨第一跖骨基底部开口向外闭合楔形截骨结合锁定钢板固定治疗中重度外翻的临床疗效。[方法]2008年3月~2014年4月共治疗32例(35足),男8例8足,女24例27足,年龄48~73岁,平均58岁,单侧29例,双侧3例,中度外翻19例(22足),重度外翻13例(13足)。采用第一跖骨基底部开口向外闭合楔形截骨,使用锁定钢板固定。术前、术后12周及末次随访时均拍摄足部负重正位X线片,测量外翻角(hallux valgus angle,HVA)、第1、2跖骨间角(inter metatarsal angle,IMA)、籽骨位置及美国足踝外科协会(AOFAS)评分。比较术前和术后随访时外翻相关的各X线片测量值以及AOFAS评分。[结果]本组病例均得到随访,随访时间13~42个月,平均26个月。术后12周时HVA由(39.83±4.58)°,改善至(11.67±1.22)°,IMA由(14.27±0.84)°改善至(7.85±0.83)°,籽骨位置由(8.35±1.82)mm改善至(3.26±0.84)mm,末次随访时HVA为(13.81±1.66)°,IMA为(9.27±0.62)°,籽骨位置为(4.14±0.57)mm,AOFAS评分由术前的(62.54±5.36)分改善至末次随访时的(92.35±6.73)分。[结论]采用第一跖骨基底部开口向外闭合楔形截骨结合锁定钢板固定治疗中重度外翻,术后临床疗效良好,外翻复发少。

[Objective] To investigate the clinical outcome of proximal closing wedge metatarsal osteotomy combined with locking plate fixation in the treatment of moderate and severe hallux valgus deformity. [Methods ] A retrospective analysis was performed in 19 patients （22 feet） with moderate hallux valgus and 13 patients （13 feet） with severe hallux valgus, who underwent proximal closing wedge metatarsal osteotomy and locking plate fixation in our hospital from March 2008 to April 2014. These patients, consisting of 8 males （8 feet） and 24 females （27 feet）, had a mean age of 58 years （48- 73 years） . And the unilateral foot was involved in 29 cases and bilateral in 3 cases. For all patients, anteroposterior X-ray of the foot was taken before surgery, at 12 weeks after surgery, and at the last follow-up to measure hallux valgus angle （HVA）, intermetatarsal angle （IMA）, and the position of sesamoid bone. At the same time, the foot function was evaluated with the American Orthopaedic Foot and Ankle Society （AOFAS） score. The preoperative and postoperative measured data were analyzed with SPSS 11.5 and compared to assess the treatment outcome. [ Results] All patients were followed up for 26 months （13-42 months） . The average HVA was 39.8°±4.5° before surgery, 11.6°± 1.2° at 12 weeks after surgery, and 13.8°±1.6° at the last follow-up. The average IMA was 14.2°±0.8°, 7.8°±0.8°, and 9.2°±0.6°, respectively. The position of sesamoid bone was 8.3±1.8 mm, 3.2±0.8 mm, and 4.1±0.5 mm, respectively. AOFAS score was 62.5±5.3 before surgery and 92.3±6.7 at the last follow-up. [Conclusions] Proximal closing wedge metatarsal osteotomy combined with locking plate fixation has good clinical outcome and a low recurrence rate in the treatment of moderate and severe hallux valgus deformity.