第一跖骨基底闭合楔形截骨联合远端软组织平衡手术治疗中重度[母]外翻25例

Clinical Report of 25 Cases for Wedge Osteotomy of the First Metatarsal Base Combined with the Balance of the Distal Soft Tissue in Treating Moderate and Severe Hallux Valgus

目的:总结采用第一跖骨基底闭合楔形截骨联合远端软组织平衡手术治疗中重度[母]外翻的疗效。方法:自2012年1月至2019年12月,对25例(28足)中重度[母]外翻患者采用第一跖骨基底楔形截骨联合远端软组织平衡手术治疗,测量手术前后[母]外翻角(HAA)及跖间角(IMA)变化情况,并采用美国足踝外科协会(AOFAS)第一跖骨、趾骨及跖趾关节、趾间关节功能评分标准评定手术前后功能。结果:切口均Ⅰ期愈合,无感染,无内固定失败,无截骨部延迟愈合或不愈合。患者外翻畸形纠正明显,[母]囊炎、转移性跖痛症均明显改善,未见畸形复发。术后测量HAA(9.643°±2.041°)及IMA(6.714°±1.357°)均较术前(分别为(43.286°±6.531°)和(20.464°±3.144°))明显减小,差异有统计学意义(P<0.01);AOFAS评分也从术前(49.786±9.480)分显著提高为末次随访的(91.750±4.169)分,差异有统计学意义(P<0.01)。结论:采用第一跖骨基底闭合楔形截骨联合远端软组织平衡手术治疗中重度[母]外翻,是一种安全有效的治疗方法。

Objective:To report the clinical efficacy of the treatment of moderate and severe hallux valgus by closed cuneiform osteotomy of the first metatarsal base combined with the balance of the distal soft tissue.Methods:25 cases(28 feet)of moderate and severe hallux valgus were treated by closed cuneiform osteotomy of the first metatarsal base combined with the balance of the distal soft tissue in our department from January 2012 to December 2019.The hallux abductus angle(HAA)and the inter metatarsal angle(IMA)were measured before and after operation.Functional evaluation were carried out according to the American orthopedic foot and ankle society(AOFAS)score system before the operation and in the last follow-up.Results:All the patients had incision healing at the first stage.The follow-ups revealed no incidence of internal fixation failure or delayed union or no union.All valgus deformities,pollicis,metatarsal pain were improved satisfactorily without recurrence.The preoperative HAA and IMA(43.286°±6.531°and 20.464°±3.144°)decreased significantly,as compared with them before the surgery(9.643°±2.041°and 6.714°±1.357°)(P<0.01).The AOFAS score was improved significantly from 49.786±9.480 before the treatment to 91.750±4.169 in the last follow-up(P<0.01).Conclusion:Closed wedge osteotomy of the first metatarsal base combined with the balance of the distal soft tissue is a safe and effective way in the treatment of moderate and severe degree hallux valgus.