外翻第1跖骨头软骨损伤的研究

Analysis of cartilage injury of first metatarsal head in hallux valgus

目的通过前瞻性研究统计、分析外翻患者第1跖骨头软骨损伤的发生概率、疼痛评分、畸形角度、好发部位、分级等,以及它们之间的相关性,从而更好指导临床工作。方法以2016年1月至2016年12月符合纳入、排除标准的外翻患者为研究对象,并将其按照有无第1跖骨头软骨损伤分为第1跖骨头软骨损伤组(73例、93足)与无第1跖骨头软骨损伤组(39例、54足),统计两组年龄、性别、术前疼痛评分,根据术中软骨损伤的程度分区、分级,利用SPSS 19.0统计软件进行统计分析。结果 (1)112例患者147足中,Ⅰ级病变25足(26.9%),Ⅱ级30足(32.3%),Ⅲ级19足(20.4%),Ⅳ级19足(20.4%);Ⅱ级占比最大;仅54足(36.7%)无软骨损伤。依据软骨病变分区,1区有软骨损伤的26足(11.1%),2区有15足(6.4%),3区有11足(4.7%),4区有28足(12.0%),5区有16足(6.8%),6区有12足(5.1%),7区有36足(15.4%),8区有49足(21.0%),9区有41足(17.5%),7、8、9区占比最大,其中有43足跖趾关节有病变,69足跖籽关节有病变,19足跖趾、跖籽关节均有病变。(2)两组患者在发病年龄、VAS疼痛评分、AOFAS功能评分、跖角(HVA)方面比较,差异有统计学意义(P<0.05);在性别组成、1-2跖骨间夹角方面比较,差异无统计学意义(P>0.05)。(3)第1跖骨头软骨损伤组患者中,软骨损伤分级与HVA角(r=0.804,P<0.001)和IMA角(r=0.725,P<0.001)之间有统计学意义上的显著正相关性;但软骨损伤面积与HVA角、IMA角无统计学意义上的相关性(P>0.05)。结论 外翻患者合并跖骨头软骨损伤的发生率高(约64%),其中二级病变的占比较高,发生在跖籽关节的概率大,软骨损伤的分级与外翻畸形角度的程度明显相关。

Objective The probability,visual analogue score,deformity angle,redilection ite and classification of first metatarsal cartilage injury in patients with hallux valgus were prospectively studied,and the correlation between them were analyzed.So as to better guide clinical work.Methods Patients with hallux valgus who met the inclusion and exclusion criteria from January 2016 to December 2016 were selected as the research object.They were divided into the first metatarsal cartilage injury group(73 cases,93 feet)and no first metatarsal cartilage injury group(39 cases,54 feet),according to the damage of the cartilage with first metatarsal bone.Age,gender and preoperative pain score were calculated.And the cartilage injury was classified and analyzed according to degree of cartilage injury during operation.Then SPSS 19.0 statistical software was used for statistical analysis.Results F①Of the 147 feet in 112 patients,25 feet(26.9%)were gradeⅠlesions,30 feet(32.3%)gradeⅡlesions,19 feet(20.4%)gradeⅢlesions and 19 feet(20.4%)gradeⅣlesions;Ⅱlevel accounted for the largest;Only 54 feet(36.7%)had no cartilage lesion.According to the subarea of cartilage lesions,there are 26 feet(11.1%)with cartilage injury in area 1,15 feet(6.4%)in area 2,11 feet(4.7%)in area 3,28 feet in area 4,16 feet(6.8%)in area 5,12 feet(5.1%)in area 6,36 feet(15.4%)in area 7,49 feet(21.0%)in area 8 and 41 feet(17.5%)in area 9.Area 7,8,9 accounted for the largest proportion.Among them,43 feet exist pathological changes in metatarsophalangeal joints,69 feet in metatarsal joint,and 19 feet in both.②The differences between the two groups were statistically significant in the age,VAS score,AOFAS score and HVA Angle,and there was no statistical difference between the gender composition and the IMA Angle.③In patients with first metatarsus bone cartilage damage,There was a significant positive correlation between cartilage injury grade and HVA angle(r=0.804,P<0.001)and IMA angle(r=0.725,P<0.001).However,there was no statistically significant correlation between the area of cartilage injury and HVA angle and IMA angle(P>0.05).Conclusion Cartilage injury incidence of metatarsal head in patients with hallux valgus is high(about 64%).Among them,the two grade lesions are relatively high.And the probability of the lesion in the metatarsal joint is high.Classification of cartilage injury is significantly related to the degree of hallux valgus deformity.