第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻

Cuneiform osteotomy of the first metatarsal base combined with modified Mcbride operation for moderate and severe hallux valgus

目的探讨第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻的疗效。方法以江苏省人民医院2010年1月至2017年8月收治的80例拇外翻患者为对象,共131足。其中中重度拇外翻68足,对此68足拇外翻患者均予以第一跖骨基底部楔形截骨联合改良Mcbride手术治疗,分析疗效。结果随访时间均为术后1年,拇外翻角、第一与二跖骨夹角、第一跖骨远端关节面角均小于术前,差异有统计学意义(P均<0. 01);并发症发生率为3. 33%(2/68)。术后1年VAS疼痛评分(1. 68±0. 12)分,较术前的(6. 65±0. 31)分降低(P <0. 01),AOFAS评分(89. 54±2. 36)分,较术前的(42. 38±3. 42)分升高(P <0. 01)。结论第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻,可改善患者症状,且并发症少,可有效缓解患者疼痛、促进足部功能康复。

Objective To explore the curative effect of the first metatarsal base wedge osteotomy combined with modified Mcbride surgery for moderate and severe hallux valgus. Methods Eighty patients with hallux valgus( 131 feet) treated in Jiangsu Province Hospital from January 2010 to August 2017. Among them,68 feet with moderate to severe hallux valgus,who were treated with the first metatarsal proximal base wedge osteotomy combined with modified Mcbride surgery. The curative effect of the operation was analyzed. Results During one year follow-up period after operation,the valgus angle,the angle between the first metatarsal and the second metatarsal,and distal metatarsal articular angle of the first metatarsal significantly decreased compared with those before operation( all P < 0. 01). The incidence of complications was 3. 33%.The VAS pain score was statistically lower than that before operation( 1. 68 ± 0. 12 vs 6. 65 ± 0. 31,P < 0. 01),and American Orthopedic Foot and Ankle Society( AOFAS) score was significantly higher than that( 89. 54 ± 2. 36 vs 42. 38 ±3. 42,P < 0. 01) before operation. Conclusion For patients with moderate and severe hallux valgus,the first metatarsal base wedge osteotomy combined with modified Mcbride surgery can improve the symptoms of patients with fewer complications and effectively alleviate the pain and promote the rehabilitation of foot function.