改良单钉旋转Scarf截骨术治疗足拇外翻畸形的临床疗效

Clinical efficacy of modified rotating Scarf osteotomy with a single screw for the treatment of halluxvalgus

目的探讨改良单钉旋转Scarf截骨术在足拇外翻手术治疗中的临床疗效。方法病例系列报告。纳入2020年12月—2021年10月徐州医科大学第二附属医院收治的拇外翻患者17例(21足),其中男3例(3足)、女14例(18足),年龄24~64(47.1±17.4)岁,左足13例、右足8例。患者均行卡槽单钉旋转Scarf截骨术治疗。观察指标:(1)术后伤口愈合情况。(2)术后定期随访,观察患者骨愈合时间,第1跖趾关节活动度,螺钉激惹、拇内翻畸形等并发症情况,以及拇外翻复发情况。(3)比较手术前及术后1年拇外翻角(HVA),第1、2跖骨间角(IMA),跖骨远端关节角(DMAA)、籽骨Handy-Clapham分度,拇囊部位疼痛视觉模拟评分法(VAS)评分,以及美国足踝外科协会(AOFAS)前足评分。结果17例患者均顺利完成手术。手术时间45~80(60.6±11.9)min。术后1例(2足)合并糖尿病患者出现伤口感染,予清创换药后,伤口愈合;其余16例患者伤口均一期愈合。患者均获随访,随访时间13~22(15.6±2.7)个月。所有患者骨质愈合,愈合时间1.5~4.0(2.5±0.6)2.5个月。1例(1足)在术后1年随访时跖趾关节僵硬,其余16例患者第1跖趾关节活动无受限。1例(1足)因螺钉激惹刺激足背皮肤,行内固定取出手术。随访期间17例患者均无拇内翻畸形,无拇外翻复发。术后1年HVA、IMA、DMAA分别为11.6°±3.9°、5.6°±2.7°、8.1°±3.9°,均小于术前的35.5°±5.9°、13.5°±1.4°、20.6°±8.2°;籽骨Handy-Clapham分度较术前改善;术后1年拇囊部位疼痛VAS评分(0.9±1.4)分,低于术前的(5.4±1.6)分;术后1年AOFAS前足评分(88.6±6.1)分,高于术前的(41.1±15.1)分:差异均有统计学意义(P值均<0.001)。结论改良单钉旋转Scarf截骨术能有效矫正拇外翻畸形,改善患者临床症状,恢复拇趾功能。

Objective To investigate the clinical efficacy of modified rotating Scarf osteotomy with a single screw for the treatment of hallux valgus.Methods This work included a series of case reports.Seventeen patients(21 feet)with hallux valgus treated with modified rotating Scarf osteotomy with a single screw in the Second Affiliated Hospital of Xuzhou Medical University from December 2020 to October 2021 were included.The patients included 3 males(3 feet)and 14 females(18 feet),aged 24-64(47.1±17.4)years old.A total of 13 left foot cases and 8 right foot cases were included.The observation indices were as follows:(1)The wound of the patients within 2 weeks after surgery was observed.(2)Follow-up was performed regularly after surgery.The time of bone healing,the range of motion of the first metatarsophalangeal joint,screw irritation,the deformity of the hallux varus,and the recurrence of the hallux valgus were observed.(3)The hallux valgus angle(HVA),intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA),sesamoid Handy-Clapham grading,pain visual analogue scale(VAS)score,and American Orthopedic Foot and Ankle Society(AOFAS)-forefoot score before and 1 year after surgery were compared.Results The operation was successfully performed in all of the 17 patients.The operation time was 45-80(60.6±11.9)min.Postoperative wound infection occurred in 1 patient(2 feet)with diabetes.After debridement and dressing change,the wound healed.The other patients experienced primary healing.All the 17 patients were followed up for 13-22(15.6±2.7)months.All the patients'bones healed with the healing time of 1.5-4.0(2.5±0.6)months.One patient(1 foot)had metatarsophalangeal joint stiffness at 1-year follow-up.The other patients had no limitation in the movement of the first metatarsophalangeal joint.One patient(1 foot)underwent surgery for screw removal due to screw irritation.No complications,such as hallux varus deformity or hallux valgus recurrence,occurred during follow-up.The HVA,IMA,and DMAA at the 1-year review were 11.6°±3.9°,5.6°±2.7°,and 8.1°±3.9°,respectively,and were lower than those before surgery(35.5°±5.9°,13.5°±1.4°,and 20.6°±8.2°).The postoperative Handy-Clapham grading of the sesamoid bone had improved compared with the preoperative grading.The VAS score at the bunion at 1 year after surgery(0.9±1.4)was lower than that before surgery(5.4±1.6),and the AOFAS-forefoot score at 1 year after surgery(88.6±6.1)was higher than that before surgery(41.1±15.1).These differences were statistically significant(all P values<0.001).Conclusion The modified rotating Scarf osteotomy with a single screw can effectively correct the deformity of the hallux valgus,improve the clinical symptoms of patients,and restore the function of the hallux toe.