外翻患者DMAA术前X线与术中克氏针标记测量结果比较

The variance analysis of preoperative and intraoperative measurement of distal metatarsal joint angle with hallux valgus

目的比较外翻患者跖骨远端关节角(DMAA)术前X线片测量结果与术中克氏针标记测量结果的差异。方法选取2016年6月至2017年10月收治58例(72足)外翻患者,手术方案均为改良Chevron截骨结合外侧软组织松解术。术前均行负重正位X线检查并测量DMAA;术中直视状态下用克氏针水平面由内向外标记跖骨远端关节面,C型臂透视患足正位及内翻10°位、外翻10°位,术后将投照影像分别测量克氏针标记下的DMAA角。比较DMAA术前X线片与术中克氏针标记测量结果,以及术中克氏针定位标记正位、内翻、外翻位DMAA测量值。结果术前正位X线片测量DMAA角为(12.17±6.37)°,术中克氏针标记测量DMAA角为(19.36±9.45)°,术中克氏针标记正位测量DMAA角显著大于术前X线片测量值(P<0.01)。术中克氏针标记内翻位投照时测量得到DMAA角较正位测量值大,外翻位投照时测量得到DMAA角较正位测量值小,差异具有统计学意义(P<0.05)。不同外翻程度术前X线片与克氏针标记下测量结果比较显示,随着外翻程度加重,DMAA角增加,差异具有统计学意义(P<0.01)。结论 外翻患者术前X线测量DMAA较术中克氏针标记实际值明显偏小,外翻矫形手术中,为到达满意矫形效果并防止术后复发,需要充分矫正跖骨远端关节面角。

Objective To compare the preoperative X-ray results of distal metatarsal joint angle(DMAA)with that of intraoperative Kirschner wire in hallux valgus.Methods A total of 58 patients with hallux valgus(72 feet)were selected from June 2016 to October 2017.All patients were treated by improved Chevron combined with lateral soft tissue loosening operation.The X-ray examination and measurement of DMAA were performed before the operation.The Kirschner wire under horizontal plane was used to mark distal metatarsal articular surface from inside to outside under intraoperative direct vision.Anteroposterior position,introversion angulation of 10°and extroversion angulation of 10°were observed by C arm fluoroscopy during operation.The postoperative DMAA angle marked by Kirschner wire was measured respectively.The results of preoperative X-ray and intraoperative Kirschner wire were compared,and also with the DMAA value of the position of the Kirschner wire in ortho,varus and eversion.Results The DMAA angle of preoperative X-ray examination was(12.17+6.37)degree;The DMAA angle measured by Kirschner wire was(19.36+9.45)degree.It suggested that the measured values of Kirschner wire marked were bigger than it of preoperative X-ray(P<0.01).The angles were measured after articular surfaces marked by Kirschner wire under anteroposterior position,introversion and extroversion during operation.It obtained(P<0.05)through the analysis of variance,the difference is statistically significant.It suggested that the DMAA angle would gain as hallux valgus aggravated after the analyzation of angle difference changes between preoperative X-ray measured and Kirschner wire marked with different levels of hallux valgus,which is statistically significant(P<0.01).Conclusion The measured values of preoperative X-ray of distal metatarsal joint angle with hallux valgus were significantly smaller than it of Kirschner wire marked during operation.So in the hallux valgus orthopedic surgery,we need to fully correct distal metatarsal joint angle to reach the satisfactory effect and to prevent recurrence.