微创截骨单螺钉固定结合外侧软组织松解治疗轻中度拇外翻

Minimally invasive osteotomy and single screw fixation with lateral soft tissue release in treating mild to moderate hallux valgus

目的探讨利用微创截骨单螺钉固定结合松解外侧软组织的方法治疗轻中度拇外翻的短期临床效果。方法回顾性分析2021年2月至2022年3月期间采用安徽医科大学第二附属医院采用微创截骨单螺钉固定结合松解外侧软组织的方法治疗16例(19足)轻中度拇外翻患者。其中,男1例(1足),女15例(18足);年龄25~78岁,平均41.9岁;轻度6例(7足),中度10例(12足)。通过测量19足术前及末次随访时拇外翻角(hallux valgus angle,HVA),第Ⅰ、Ⅱ跖骨间夹角(Ⅰ-ⅡIMA),第Ⅰ跖骨远端关节面角(distal metatarsal articular angle,DMAA)变化情况,并采用美国足踝外科学会(American Orthopaedic Foot and Ankle Society,AOFAS)拇趾关节评分系统进行疗效评价。结果16例(19足)患者均获得随访,随访时间7~18个月,平均12.5个月。术前HVA(27.2±6.8)°、Ⅰ-ⅡIMA(16.9±4.2)°、DMAA(11.2±3.5)°、AOFAS评分(57.2±8.8)分,末次随访时HVA(8.7±5.1)°、Ⅰ-ⅡIMA(7.1±3.3)°、DMAA(4.1±2.1)°、AOFAS评分(88.2±3.6)分,术前与末次随访时HVA、Ⅰ-ⅡIMA、DMAA及AOFAS评分比较,差异均有统计学意义(P<0.05)。末次随访时AOFAS评分结果:优10足,良7足,可2足。术后2例患者出现切口周围红肿,加强护理后愈合良好。未出现切口感染及跖骨头坏死并发症。结论微创截骨单螺钉固定结合松解外侧软组织的方法可以有效治疗轻中度拇外翻,取得满意的临床效果。

Objective To explore the short-term results of minimally invasive osteotomy and single screw fixation with lateral soft tissue release in treating mild to moderate hallux valgus.Methods Sixteen patients(19 feet)with mild to moderate hallux valgus treated with minimally invasive osteotomy and one screw fixation with lateral soft tissue release in the Second Hospital of Anhui Medical University from February 2021 to March 2022 were retrospectively analyzed.There were 1 male(1 foot)and 15 females(18 feet),aged from 25 to 78 years old,with an average of 41.9 years old;6 patients(7 feet)with mild hallux valgus,and 10 patients(12 feet)with moderate hallux valgus.The changes of hallux valgus angle(HVA),Ⅰ-Ⅱintermetatarsal angle(Ⅰ-ⅡIMA),and distal metatarsal articular angle(DMAA)were measured and compared before operation and at the final follow-up,and the American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal(AOFAS Hallux MTP-IP)scale was used to evaluate clinical effects.Results Sixteen patients(19 feet)were followed-up for 7 to 18 months,with an average of 12.5 months.Before operation,the HVA was(27.2±6.8)°,Ⅰ-ⅡIMA was(16.9±4.2)°,DMAA was(11.2±3.5)°and AOFAS was(57.2±8.8).At the final follow-up after operation,they were(8.7±5.1)°,(7.1±3.3)°,(4.1±2.1)°and(88.2±3.6).There were significant differences between these indices at preoperative and postoperative follow-up(P<0.05).At the final follow-up after operation,the AOFAS score was excellent in 10 feet,good in 7 feet and moderate in 2 feet.In two patients,redness and swelling occurred around the incision at the osteotomy site and were cured by a change of stronger dressing.There were no complications such as incision infection and metatarsal head necrosis.Conclusion Minimally invasive osteotomy and single screw fixation with lateral soft tissue release could be effective in the treatment of mild to moderate hallux valgus,and achieved satisfactory clinical results.