经皮微创截骨术联合8字绷带和分趾垫外固定治疗中度拇外翻

Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus

目的:探讨经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻的临床疗效。方法:自2019年8月至2021年1月采用经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻患者23例,失访1例,最终纳入22例(30足),男4例6足,女18例24足,年龄27~66(50.59±11.95)岁。比较术前和术后6个月患足拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨跨度(第1、5跖骨头之间的距离)和软组织宽度变化情况,并采用美国足踝外科协会踝-后足评分标准(American Orthopaedic Foot and Ankle Society,AOFAS)进行临床疗效评价,采用视觉模拟评分(visual analogue scale,VAS)评价足部自觉疼痛情况。结果:22例患者获得随访,时间5.7~6.4(6.13±0.85)个月。患者第1跖骨截骨处均获得骨性愈合,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。术后6个月患足HVA、IMA、跖骨跨度、软组织宽度、VAS、AOFAS评分较术前改善(P<0.01)。术后6个月根据AOFAS评分,优10足,良18足,差2足,2例评分差患足经过延长“8”字绷带和分趾垫外固定时间达到优。结论:经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻能够较好地纠正足部拇外翻畸形,减轻足部症状,术后功能恢复良好,临床疗效显著。

Objective To observe clinical effect of percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation in treating moderate hallux valgus.Methods Totally 23 patients with moderate hallux valgus were treated with percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation from August 2019 to January 2021,and 1 patient was loss to follow-up,and finally 22 patients(30 feet)were included,4 males(6 feet)and 18 females(24 feet),aged from 27 to 66 years old with an average of(50.59±11.95)years old.Hallux valgus angle(HVA),intermetatarsal angle(IMA),metatarsal span(the distance between the first and the fifth metatarsal bones),changed of soft tissue width,American Orthopaedic Foot and Ankle Society(AOFAS)score,and Visual Analogue Scale(VAS)were collected and compared before operation and 6 months after operation.Results Twenty-two patients were followed up from 5.7 to 6.4 months with an average of(6.13±0.85)months.The first metatarsal osteotomy of patients were obtained bone union,and deformity of the toes was corrected.Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not occurred.Postoperative HVA,IMA,metatarsal span,soft tissue width,VAS,AOFAS score at 6 months were significantly improved compared with pre-operation(P<0.01).According to AOFAS score at 6 months after operation,10 feet were excellent,18 good and 2 poor.Two feet with poor were excellent after prolonged 8-shaped bandage and hallux valgus splint fixation time.Conclusion Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus could better correct deformity of hallux valgus,relieve foot symptoms,good recovery of postoperative function,and has a significant clinical efficacy.