微创截骨治疗小趾囊炎足底压力变化

Variation of plantar pressure before and after minimally invasive osteotomy for Tailor’s bunion

[目的]探讨微创截骨技术治疗小趾囊炎足底压力变化。[方法] 2017年4月~2018年9月采用微创截骨手术治疗小趾囊炎患者37例(71足)纳入本研究,另外选择33例66足正常者对照。采用Footscan足底压力系统于术前和末次随访时测量第1跖骨至第5跖骨(M1-M5)动态峰值压力(peak force, PF)、压强(peak pressure, PP)和冲量(peak impulse, PI)。[结果]患者均顺利手术,且随访(14.13±2.02)个月。正常人组各跖骨头的PF、PP和PI由大到小依次为M2>M3>M1>M4>M5,而术前患者组为M5>M3>M2>M4>M1,但末次随访时,患者组改变为M2>M3>M1>M4>M5,与正常人组各跖骨头应力分布一致。患者组术前M2-M5的PF、PP和PI值均显著高于正常人组(P<0.05),但是末次随访时患者组M1~M5的PF、PP和PI与正常人组相比差异均无统计学意义(P>0.05)。患者组术前与末次随访时PF、PP和PI比较,各跖骨头的PF、PP和PI均显著减小,其中M2~M5的3项力学指标两组间差异有统计学意义(P<0.05),而M1的2项力学指标差异无统计学意义(P>0.05)。患者的年龄与术前第5跖骨头PP呈正相关。[结论]微创截骨技术可有效恢复前足正常负重。

[Objective] To explore the changes of plantar pressure before and after minimally invasive osteotomy for Tailor’s bunion.[Methods] A total of 37 patients(71 feet) who were undergoing the minimally invasive osteotomy for Tailor’s bunion were enrolled in this study, in addition, 33 healthy(66 feet) were selected as the control. The plantar pressure parameters on the first metatarsal to the fifth metatarsal heads, including peak force(PF), peak pressure(PP) and peak impulse(PI), were measured by using footscan plantar pressure test system before operation and at the latest follow-up in the patients and the healthy persons. [Results] All the patients had minimally invasive osteotomy performed smoothly without serious complications, and followed up for(14.13±2.02) months on average. The PF, PP and PI were ranked up-down in the healthy group in a sequence of M2>M3>M1>M4>M5, whereas M5>M3> M2>M4>M1 in the patients group before operation, however which turned to be consistent to the sequence of the healthy group at the latest follow-up. The PF, PP and PI on the M2 to M5 in the patients group before operation proved significantly greater than the healthy group(P<0.05), which became not statistically significant between the two groups at the latest follow-up(P>0.05). Compared with those before operation the PF, PP and PI decreased in the patient group at the latest follow-up, which was statistically significant on the M2 to M5(P<0.05), whereas not significant in the PF and PI on the M1(P>0.05). In addition, there was a significantly positive correlation between the PP on the M5 and age of the patients before operation(P<0.05). [Conclusion] This minimally invasive osteotomy for Tailor’s bunion does recover the normal plantar stress distribution on the forefoot.