微创跖骨近端截骨联合Akin截骨术治疗重度外翻

Efficacy of minimally PCWO combined with Akin osteotomy on severe hallux valgus

目的探讨微创跖骨近端闭合楔形截骨术(proximal closing wedge osteotomy,PCWO)联合Akin截骨术治疗重度外翻的临床疗效。方法选取2016年8月至2018年8月重度外翻患者45例(50足),其中男14例,女31例;年龄(40.1±13.0)岁(范围17~67岁)。50足均采用微创PCWO联合Akin截骨术治疗。术前、术后3个月、6个月、12个月、末次随访时均通过X线片测量外翻角(hallux valgus angle,HVA),第一、二跖骨间角(intermetatarsal angle,IMA),跖骨远端关节角(distal metatarsal articular angle,DMAA),跖趾关节远端固定角(distal articular set angle,DASA),趾骨间角(interphalangeal angle,IPA),参照美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分和Olerud-Molander主观功能评分(Olerud-Molander ankle score,OMA)标准进行疗效评定,测量术前、末次随访时第一跖骨的绝对长度、相对长度并计算前后差值。结果45例术后均获随访,随访时间(18.20±2.04)个月(范围12~22个月)。无复发病例,无转移性跖痛。术前,术后3、6、12个月及末次随访的HVA分别为42.83°±4.63°、12.83°±1.53°、13.49°±1.33°、14.08°±1.49°、14.12°±1.35°,术后各节点与术前比较差异均有统计学意义(P<0.05);术前,术后3、6、12个月及末次随访的IMA分别为18.29°±0.94°、7.84°±1.22°、8.31°±1.03°、9.01°±1.08°、9.09°±1.11°,术后各节点与术前比较差异均有统计学意义(P<0.05)。术前,术后3、6、12个月及末次随访的AOFAS评分分别为(50.64±7.94)分、(88.80±2.68)分、(90.10±3.51)分、(91.20±3.89)分、(91.37±3.71)分,术后各节点与术前比较差异均有统计学意义(P<0.05);术前,术后3、6、12个月及末次随访的OMA评分为(61.00±7.00)分、(90.90±5.02)分、(91.60±4.57)分、(93.20±3.61)分、(93.48±4.91)分,术后各节点与术前比较差异均有统计学意义(P<0.05)。末次随访与术前比较,第一跖骨绝对短缩3.03 mm,相对短缩0.72 mm。结论微创PCWO联合Akin截骨术治疗重度外翻可有效矫正外翻畸形,并且手术切口小,安全性高,疗效确切,值得在临床上推广应用。

Objective To study the efficacy of minimally PCWO combined with Akin osteotomy on severe hallux valgus.Methods This retrospective study was conducted on 45 patients(50 feet)with severe hallux valgus treated by minimally PCWO combined with Akin osteotomy in Eight Department of Bone,Foshan Hospital of traditional Chinese Medicine from August 2016 to August 2018.HVA,IMA,DMAA,DASA,IPA were measured by X-ray examination preoperatively and after operative 3,6,12 months and at the final follow-up.The efficacy was evaluated in accordance with the American Orthopaedic Foot and Ankle Association(AOFAS)Ankle Hindfoot Scale and the Olerud-Molander Ankle(OMA)Score.The absolute and relative lengths of the first metatarsus were measured by X-ray examination preoperatively and at the last follow-up,with calculating the differences.Result All patients were followed up within 18.20±2.04 months.There was no recurrence during follow-up period.HVA was 42.83°±4.63°,12.83°±1.53°,13.49°±1.33°,14.08°±1.49°and 14.12°±1.35°at the preoperative,postoperative 3 months,6 months,12 months and the last follow-up,respectively,and the difference between pre-operation and post-operation was statistically significant(P<0.05).IMA was 18.29°±0.94°,7.84°±1.22°,8.31°±1.03°,9.01°±1.08°and 9.09°±1.11°at the preoperative,postoperative 3 months,6 months,12 months and the last follow-up,respectively,and the difference between pre-operation and post-operation was statistically significant(P<0.05).AOFAS scores were 50.64±7.94,88.80±2.68,90.10±3.51,91.20±3.89 and 91.37±3.71 points at the preoperative,postoperative 3 months,6 months,12 months and the last follow-up,respectively,and the difference between pre-operation and post-operation was statistically significant(P<0.05).The OMA scores were 61.00±7.00,90.90±5.02,91.60±4.57,93.20±3.61 and 93.48±4.91 at preoperative,postoperative 3 months,6 months,12 months and the last follow-up,respectively,and the difference between pre-operation and post-operation was statistically significant(P<0.05).The absolute shortening of the first metatarsal was 3.03 mm and relative shortening was 0.72 mm.Conclusion For severe hallux valgus,minimally PCWO combined with Akin osteotomy can effectively correct the hallux valgus deformity with small surgical incision,high safety and curative effect,which is worthy of popularization and application in clinical.