Wilson截骨手术对功能性拇僵硬的临床疗效分析

Analysis of the clinical effect of Wilson osteotomy on functional hallux rigidus

目的分析Wilson截骨对功能性拇趾僵硬的临床疗效。方法选取2017年8月至2019年4月解放军总医院第七医学中心收治的功能性拇趾僵硬并行Wilson截骨的34例患者,术前、术后末次随访时分别记录美国矫形足踝协会(American Orthopedic Foot and Ankle Society,AOFAS)评分、视觉模拟评分(visual analogue score,VAS),负重时拇趾背伸角度、拇外翻角。结果本组34例患者(56足),均为军人、男性;年龄19~35岁,平均(22.5±2.1)岁。其中双足22例(64.7%),单足12例(35.3%)。术后末次随访时VAS评分由3.9±1.0降至0.4±0.3、负重时拇趾背伸角度由(18.7±6.4)°增至(60.9±11.3)°、AOFAS评分由61.3±6.9增至83.2±4.7、拇外翻角由(20.0±4.1)°降至(10.0±2.4)°,均较术前明显改善,差异有统计学意义(P<0.001)。结论Wilson截骨通过短缩、下沉、外移第1跖骨远端可以很好地缓解第1跖趾关节腔压力,恢复正常的关节运动轨迹,对于功能性拇僵硬治疗效果显著。

Objective To analyze the effect of Wilson osteotomy on functional hallux rigidus.Methods Patients with functional hallux rigidus and received Wilson osteotomy admitted in the Seventh Medical Center of PLA General Hospital from August 2017 to April 2019 were selected.American Orthopedic Foot and Ankle Society(AOFAS)score,visual analogue scale(VAS)score,and the angle of hallux dorsal extension when weight bearing before and after operation were compared to analyze the effect of Wilson osteotomy.Results A total of 34 patients(56 feet)were selected,all of whom were military men,including double feet 22 cases(64.7%)and single foot 12 cases(35.3%),aged 19 to 35 years,with an average age of 22.5±2.1 years.The pain degree,the angle of hallux dorsal extension when weight-bearing,and the AOFAS score were significantly improved at the last postoperative follow-up compared with those before operation(P<0.01).Conclusions Wilson osteotomy can relieve the pressure of the first metatarsophalangeal joint cavity by shortening,sinking,and moving the distal end of the first metatarsal bone,and restore the normal joint trajectory.The effect of Wilson osteotomy on functional hallux rigidus is significant.