小切口第1跖骨远端截骨术联合“8”字绷带弹性外固定治疗拇外翻畸形

Treatment of Hallux Valgus Deformity with Mini Incision Distal First Metatarsal Osteotomy Combined with"8"Bandage Elastic External Fixation

目的探讨小切口第一跖骨远端截骨术联合"8"字绷带弹性外固定治疗拇外翻的临床疗效。方法选自2016年7月~2020年1月收治拇外翻患者21例,采用第一跖骨远端截骨术结合外侧软组织松解术、"8"字绷带弹性外固定术治疗,术后随访10个月,末次测量患足拇外翻角(Hallux Valgus Angle,HVA)及第1、2跖骨间角(Inter Metatarsal Angle,IMA),并采用AOFAS评分比较手术前后临床疗效。结果术后患足21例切口均I期愈合(100%),未出现并发症(切口感染、跖骨头坏死、转移性跖骨痛、拇外翻畸形复发等);术前HVA (34.41±4.25)0、IMA(14.35±1.04)0,术后(10.46±1.15)0、(7.96±0.60)°,差异有统计学意义(p<0.05);AOFAS评分:术前56.33±5.47分,术后96.19±3.84分,差异有统计学意义(p<0.05)。结论小切口第一跖骨远端截骨术联合"8"字绷带弹性外固定法简单易学,具有手术视野暴露充分、患者舒适的优点,临床效果较好,值得进一步推广使用。

Objective:To investigate the clinical effect of mini incision distal first metatarsal osteotomy combined with"8"bandage elastic external fixation in the treatment of hallux valgus.Methods:A total of 21 patients with hallux valgus were selected from July 2016 to January 2020.They were treated with the distal first metatarsal osteotomy combined with lateral soft tissue lysis and"8"bandage elastic external fixation.The postoperative follow-up was 10 months.The hallux valgus angle(Hallux Valgus Angle,HVA)and the first and second metatarsal angles(Inter Metatarsal Angle,IMA)were measured at the last time,and the AOFAS score was used to compare the clinical efficacy before and after the operation.Results:All the 21 cases of foot incision healed at stage I(100%)after operation,without complications(incision infection,metatarsal head necrosis,metastatic metatarsal pain,recurrence of hallux valgus deformity,etc.).Preoperative HVA(34.41±4.25)°and IMA(14.35±1.04)°were both higher than postoperative[(10.46±1.15)°,(7.96±0.60)°],the differences were statistically significant(p<0.05).The preoperative AOFAS score was(56.33±5.47)points,higher than(96.19±3.84)points after operation,the difference was statistically significant(p<0.05).Conclusion:The mini incision distal first metatarsal osteotomy combined with"8"bandage elastic external fixation is simple and easy to learn.It has the advantages of full exposure of the surgical field and comfort of the patient.The clinical effect is good,and it is worthy of further promotion.