经皮微创截骨术联合“裹帘法”固定治疗重度[足母]外翻的临床研究

Clinical Study of Percutaneous Minimally Invasive Osteotomy Combined with“Wrapped Curtain Method”Fixation on the Treatment of Severe Hallux Valgus

目的:观察经皮微创截骨术联合“裹帘法”固定治疗重度[足母]外翻的临床疗效。方法:2019年8月至2021年1月,采用经皮微创截骨术联合“裹帘法”治疗重度[足母]外翻患者20例(30足)。手术前后拍摄负重位X线片测量患足[足母]外翻角(Hallux Valgus Angle,HVA),第一、二跖骨间角(Inter Metatarsal Angle,IMA),跖骨跨度(第一和第五跖骨头之间的距离),软组织宽度(软组织轮廓的最大距离),美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分标准评分,视觉模拟量表(VAS)疼痛评分。结果:20例患者得到有效随访,随访时间为6个月,患者第一跖骨截骨处均骨性愈合,足趾外观畸形得到纠正,术后患足未出现跖骨头缺血性坏死、转移性跖骨痛等并发症。通过术前、术后自身对照分析,HVA、IMA、跖骨跨度、软组织宽度较术前显著减小,AOFAS评分较术前增高,VAS评分较术前降低,差异均有统计学意义(P<0.01)。结论:经皮微创截骨术联合“裹帘法”固定治疗重度[足母]外翻能够较好地纠正足部[足母]外翻畸形,术中损伤小,操作简便,术后功能恢复良好,临床疗效显著。

Objective:To observe the clinical efficacy of percutaneous minimally invasive osteotomy combined with“Wrapped Curtain Method”fixation on the treatment of severe hallux valgus.Methods:20 patients(30 feet)with severe hallux valgus were treated with percutaneous minimally invasive osteotomy from August 2019 to January 2021.Weight-bearing position X-ray of the affected feet was taken to measure the hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA),the distance between first and fifth metatarsal bones and maximum distance for soft tissue contours before and after operation.American Orthopaedic Foot and Ankle Society(AOFAS)scores and Visual Analogue Scale(VAS)scores were collected pre-operation and post-operation.Results:The follow-up was 6 months and 20 patients were followed up effectively.The first metatarsal osteotomy of the patients developed bone union.The deformity of the toes was corrected.Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not detected post-operation.HVA,IMA,metatarsal span,and soft tissue width were significantly reduced compared with that of pre-operation.The AOFAS scores were higher and the VAS scores were lower than that of pre-operation.The differences were statistically significant(P<0.01).Conclusion:Percutaneous minimally invasive osteotomy combined with“Wrapped Curtain Method”fixation on the treatment of severe hallux valgus can better correct the deformity of the hallux valgus with easy operation.It has minimal intraoperative injury,good postoperative functional recovery and significant clinical efficacy.