Scarf联合Akin手术治疗拇外翻的疗效

Efficacy of Scarf combined with Akin surgery in the treatment of hallux valgus

目的探究Scarf联合Akin手术治疗对拇外翻的疗效、骨代谢水平及术后并发症的影响。方法选取2018年4月~2020年2月四川大学华西医院就诊的拇外翻患者104例(150足),采用随机数字表法将其分为观察组(52例,73足)和对照组(52例,77足)。对照组给予Chevron联合Akin截骨术治疗,观察组给予Scarf联合Akin截骨术治疗,并对两组患者追踪随访。比较两组患者术前及术后12个月的疼痛情况(视觉模拟评分VAS),血清骨代谢水平[Ⅰ型前胶原氨基端前肽(PINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、骨钙素(OC)],行走状况[功能性步行量表(FAC)、Berg平衡量表(BBS)],影像学指标[拇外翻角(HVA)、第1、2跖骨间夹角(IMA)、远端关节面固有角(DMAA)]变化,治疗效果[美国足踝外科学会足功能评分系统(AOFAS)]。记录两组患者术后并发症发生情况。结果两组患者术前的VAS评分、BBS评分、AOFAS评分、血清骨代谢指标(PINP、β-CTX、OC)水平、影像学指标(HVA、IMA、DMAA)、疼痛程度、FAC行走能力分级及足功能评价比较,差异无统计学意义(均P>0.05);术后12个月时,两组患者的VAS评分、血清PINP水平、DMAA值显著低于术前(均P<0.05),血清β-CTX水平及AOFAS评分显著高于术前(均P<0.05),疼痛程度评价、FAC行走能力分级、足功能评价较术前显著改善,差异有统计学意义(均P<0.05),但组间比较差异无统计学意义(均P>0.05)。两组患者术后12个月时的BBS评分较术前显著提高(P<0.05),HVA、IMA值较术前显著降低(均P<0.05),且两组间比较差异有统计学意义(均P<0.05)。两组患者术后拇内翻、跖趾关节活动受限、矫正不足及复发等并发症的发生率比较差异无统计学意义(P>0.05)。结论Scarf联合Akin截骨术、Chevron联合Akin截骨术对拇外翻患者均有良好的治疗效果,前者在改善HVA、IMA夹角及患者术后平衡能力的效果更佳。

Objective To explore the influence of Scarf combined with Akin surgery on efficacy,bone metabolism and postoperative complications of hallux valgus.Methods A total of 104 patients with hallux valgus(150 feet)who came to the hospital for treatment were selected between April 2018 and February 2020,and they were divided into observation group(52 cases,73 feet)and control group(52 cases,73 feet)by using the random number table method.Control group was given Chevron combined with Akin osteotomy treatment,and observation group was given Scarf combined with Akin osteotomy treatment,and the two groups of patients were followed up.The pain status(visual analogue score,VAS),serum bone metabolism[procollagen I type N-terminal peptide(PINP),βcross-linked C-telopeptide of type I collagen(β-CTX),osteocalcin(OC)],walking status[Functional Ambulation Category Scale(FAC),Berg Balance Scale(BBS)],imaging indicators[hallux valgus angle(HVA),intermentatarsal angle(IMA)of first and second metatarsals,distal metatarsal articular angle(DMAA)]and treatment effect[American Orthopedic Foot and Ankle Society(AOFAS)]were compared between the two groups of patients before surgery and at 12 months after surgery.The occurrence of postoperative complications were recorded in the two groups.Results There were no statistically significant differences in VAS score,BBS score,AOFAS score,serum bone metabolism indicators(PINP,β-CTX,OC),imaging indicators(HVA,IMA,DMAA),pain degree,FAC walking ability classification and foot function evaluation between the two groups(all P>0.05).A t 12 months after surgery,the VAS score,serum PINP level and DMAA value in the two groups were significantly lower than those before surgery(all P<0.05),while the level of serumβ-CTX and AOFAS score were significantly higher than those before surgery(all P<0.05),and the evaluation of pain degree,FAC walking ability classification and foot function evaluation were significantly improved compared with those before surgery(all P<0.05),but there was no statistical significance between the groups(all P>0.05).BBS score at 12 months after surgery was significantly increased compared to before surgery(all P<0.05)while HVA and IMA were significantly decreased compared to before surgery(all P<0.05),and the differences between the two groups were statistically significant(all P<0.05).There were no statistical differences in the incidence rates of postoperative complications such as postoperative hallux varus,metatarsophalangeal joint movement limitation,insufficient correction and recurrence between the two groups(P>0.05).Conclusion Scarf combined with Akin osteotomy and Chevron combined with Akin osteotomy both have good therapeutic effect on patients with hallux valgus,and the former one is more effective in improving HVA angle,IMA angle and postoperative balance ability of patients.