老年外翻患者第一跖趾关节融合术翻修的临床疗效

Clinical effect of arthrodesis of the first metatarsophalangeal joint for the recurrence of hallux valgus deformity in elderly patients

背景:外翻畸形是临床常见疾病,手术是治疗该病的主要手段。外翻翻修稳定足趾第一序列至关重要,选择第一跖趾关节融合翻修是一种不错的选择。目的:探讨老年外翻患者第一跖趾关节融合术翻修的临床疗效。方法:收集2013年6月至2016年10月间采用第一跖趾关节融合术翻修外翻术后失败患者65例(77足)。记录或测量并比较术前与末次随访时患者足部疼痛视觉模拟评分(VAS)、美国骨科足踝外科学会第一跖趾关节百分评分法评分(AOFANS评分)、外翻角(HVA)及第一、二跖间角(IMA)。结果:所有患者随访18～48个月,平均随访(23.6±0.6)个月。每足平均手术时间(30±13)min。术后8～10周第一跖趾关节处骨性愈合,无迟延及不愈合发生。所有患者末次随均小于术前,且差异均有统计学意义(t=3.217、11.37、13.67、21.321,P均<0.05)。根据AOFANS评分对本组患者进行疗效评价:优,42足;良,30足;可,5足;差:0足;优良率为93.5%(72/77)。结论:第一跖趾关节融合术翻修外翻可以有效地稳定第一序列,改善患者临床疼痛症状、纠正外翻畸形,临床疗效明确。但对术后有穿高跟鞋需求的患者慎用该术式。

Background: Hallux valgus deformity is a common clinical disease, and surgery is the main treatment. The arthrodesis of the first metatarsophalangeal joint can stabilize the first array and is supposed to be a good choice for the recurrence ofhallux valgus in elderly patients. Objective: To explore clinical effect of the arthrodesis of the first metatarsophalangeal joint onthe recurrence of hallux valgus deformity in elderly patients. Methods: From June 2013 to October 2016, 65 patients(77 feet)with recurred hallux valgus deformity were treated with the arthrodesis of the first metatarsophalangeal joint. The visual analogscale(VAS) score, AOFANS score, hallux valgus angle(HVA) and intermetatarsal angle(IMA) were recorded and measuredpreoperatively and at the last follow-up. Results: All the patients were followed up for(23.6±0.6) months on average(range, 18-48 months). The average operation time for each foot was(30±13) min. The first metatarsophalangeal joint was healed at 8 to 10 weeks after surgery. No delayed union or nonunion occurred. Compared with preoperative ones, VAS score, HVA and IMA weresignificantly decreased at the last follow-up(t=3.217, 13.67, 21.321, P<0.05), while AOFANS score was significantly in-creased(t=11.37, P<0.05). According to the AOFANS score, the efficacy was excellent in 42 feet, good in 30 feet, fair in 5 feet.The excellent and good rate was 93.5%(72/77). Conclusions: The arthrodesis of the first metatarsophalangeal joint can effectively stabilize the first array, relieve the pain and correct the hallux valgus deformity in the treatment of recurrence of hallux valgusdeformity. However, this procedure should be used with caution in patients who are eager to wear high heels after surgery.