软组织平衡术联合第一跖骨双截骨治疗中重度青少年(足母)外翻

Outcome of the soft tissue balancing with double metatarsal osteotomy for correction of moderate and severe adolescent hallux valgus

目的探讨软组织平衡术联合第一跖骨双截骨治疗中重度青少年[足母]外翻的疗效。方法纳入2012年1月至2016年12月在哈励逊国际和平医院采用软组织平衡术联合第一跖骨双截骨治疗并获随访的中重度青少年[足母]外翻患者25例(30足),其中男3例(4足),女22例(26足),年龄14~30岁,平均(19.7±3.4)岁。比较术前、术后末次随访时的[足母]外翻角(hallux valgus angle,HVA),第一、二跖骨间角(inter metatarsal angle,IMA),跖骨远端关节面角(distal metatarsal articular angle,DMAA),并采用美国足踝矫形协会(American Orthopaedic Foot and Ankle Society,AOFAS)[足母]趾-跖趾-趾间关节功能评分进行前足功能评价。结果25例患者随访时间2~4年,平均2.3年。所有患者截骨处愈合良好,无[足母]内翻发生,无转移性跖痛症。与术前比较,术后末次随访时HVA、IMA、DMAA及AOFAS评分均明显改善,差异有显著性(P<0.05)。3足术后出现[足母]趾内侧麻木,考虑最内侧皮神经损伤,给予神经营养药物治疗后半年内均恢复。结论软组织平衡术联合第一跖骨双截骨手术方式简单,矫正畸形能力强,患者可以早期下地活动,并发症较少,是治疗中重度青少年[足母]外翻的理想方法。

Objective To explore the curative effect of soft tissue balancing with double first metatarsal osteotomy for correction of moderate and severe adolescent hallux valgus.Method From January 2012 to December 2016,30 cases of moderate and severe adolescent hallux valgus(40 feet)underwent double metatarsal osteotomy combined soft tissue realignment procedure.Patients’age ranged from 14 to 30 years old,with an average of 19.7 years.The hallux valgus angle(HVA),intermetatarsal angle(IMA)and distal metatarsal articular angle(DMAA)before operation and at the last follow-up postoperation were measured and compared.The patients were assessed by the American Orthopedic Foot and Ankle Society(AOFAS)hallux etatarsophalangeal joint,interphalangeal joint score and recorded complications occurrence.SPSS 19.0 was used to do the statistics.Result Of the original 30 patients,25 patients(30 feet)were followed up.The mean durations of follow-up was 2.3 years(range from 2 to 4 years).There was significantly difference in HVA,IMA,DMAA and AOFAS postoperation in the last follow up compared with preoperation(P<0.05).Conclusion The soft tissue balancing with double metatarsal osteotomy procedure was an ideal method coping with moderate and severe adolescent hallux,as it was easy to carried out,could strongly correct the deformities with fewer complications and allowed patients standing on fields earlier.