Scarf截骨联合Akin截骨治疗中重度[足母]外翻的疗效研究:Akin截骨处是否需要内固定?

The efficacy of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate and severe hallux valgus:Does Akin osteotomy require internal fixation?

目的 探索Scarf截骨联合Akin截骨在治疗中重度[足母]外翻中Akin截骨处不行内固定的临床疗效。方法 收集包头医学院第一附属医院通过行Scarf截骨联合Akin截骨治疗的40例中重度[足母]外翻病例,按照随机数字表法分为两组,实验组行Scarf截骨联合Akin截骨,Akin截骨后不行内固定;对照组行相同术式,但Akin截骨后以双加压螺钉固定。观察术后并发症的发生情况及截骨愈合时间,评价各自组内术前、术后、末次随访时的第1、2跖骨间角(first-second metatarsal angle,IMA)、[足母]外翻角(hallux valgus angle,HVA)及跖骨远端关节角(distal metatarsal joint angle,DMAA)变化,评价术前、末次随访时的美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分。结果 38例得到随访,随访时间8~24个月,平均16.6个月。术后两组组间Akin截骨愈合时间无差异(P> 0.05);两组组内术前、术后IMA、HVA、DMAA有显著差异(P <0.01)。术前两组组间AOFAS评分无差异(P> 0.05);两组组内术前、术后AOFAS评分有显著差异(P <0.01)。两组组间术后的并发症发生率无差异(P> 0.05)。结论 Scarf截骨联合Akin截骨治疗中重度[足母]外翻的疗效良好,Akin截骨处可不行内固定处理。

Objective To explore the clinical effect of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate and severe hallux valgus without internal fixation at Akin osteotomy.Methods 40 cases of moderate and severe hallux valgus treated by Scarf osteotomy combined with Akin osteotomy in the first Affiliated Hospital of Baotou Medical College were collected and randomly divided into 2 groups.The experimental group underwent Scarf osteotomy combined with Akin osteotomy,and internal fixation was not allowed after Akin osteotomy;The control group underwent the same operation,but Akin osteotomy was followed by double compression screw fixation.The postoperative complications and osteotomy healing time were observed,and the changes of IMA,HVA and DMAA before and at the last follow-up were evaluated;the AOFAS score before and at the last follow-up was evaluated.Results 38 cases were followed up for 8~24 months with an average of 16.6 months.There was no significant difference in the healing time of Akin osteotomy between the two groups after operation(P>0.05);There were significant differences in IMA,HVA and DMAA between the two groups before and after surgery(P<0.01).There was no significant difference in AOFAS score between the two groups after operation(P>0.05);There were significant differences in AOFAS scores between the two groups before and after surgery(P<0.01).There were no obvious complications in the two groups(P>0.05).Conclusion The effect of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate and severe hallux valgus is good,and internal fixation is not required at Akin osteotomy.