应用阴阳锉跖趾关节成形治疗Freiberg病的临床研究

Clinical study on the application of yin-yang file in shaping the metatarsophalangeal joint for the treatment of Freiberg's disease

目的 探讨应用阴阳锉辅助进行跖趾关节成形配合间质填充治疗Freiberg病的临床疗效。方法 选取2019年8月至2023年9月郑州市骨科医院收治的30例Freiberg病患者。其中,男6例,女24例;年龄17~45岁,平均(26.5±6.8)岁。根据Smillie分期:Ⅲ期13例,Ⅳ期9例,Ⅴ期8例。均采用阴阳锉辅助进行跖趾关节成形配合间质填充治疗。术后采用AOFAS评分系统及跖趾关节屈伸活动度进行评价手术效果。结果 所有患者均获得随访,随访时间6~36个月,平均(26.5±13.9)个月。所有患者伤口均Ⅰ期愈合;AOFAS评分由术前(55.3±6.2)分提高到术后6个月的(90.8±5.9)分,差异有统计学意义(P<0.05),所有患者症状得到明显改变;跖趾关节活动度术前跖屈(20.3±5.3)°、背伸(15.2±5.6)°与术后6个月随访测量跖屈(18.9±5.1)°、背伸(14.1±5.2)°相比较,差异无统计学意义(P>0.05)。结论 采用阴阳锉辅助进行跖趾关节成形配合间质填充来治疗该疾病,该术式创伤小,操作简单,既减轻的疼痛症状,又保留了跖趾关节的外形及活动度,改善了患者的生活质量,是较为可靠的一种治疗方案,值得推广应用。

Objective To explore the clinical efficacy of using yin-yang files to assist in the plastic of metatarsophalangeal joint combined with interstitial filling with the treatment of Freiberg's disease.Methods Thirty patients with Freiberg's disease who visited Zhengzhou Orthopaedic Hospital from August 2019 to September 2023 were selected.There were 6 males and 24 females,aged from 17 to 45 years old,with an average of(26.5±6.8)years old.According to the Smillie staging,there were 13 cases in stageⅢ,9 cases in stageⅣ,and 8 cases in stageⅤ.All cases were treated with yin-yang files as an adjunct to the plastic and interstitial filling of the metatarsophalangeal joint.After surgery,the AOFAS scoring system was used to evaluate the surgical effect.Results All patients were followed up for a duration of 6-36 months,with an average of(26.5±13.9)months,and all patients had stageⅠwound healing.The AOFAS score increased from preoperative(55.3±6.2)points to(90.8±5.9)points at 6 months after operation,with a statistically significant difference(P<0.05).All patients showed a significant change in symptoms.The preoperative plantar flexion(20.3±5.3)°and dorsiflexion(15.2±5.6)°were compared with postoperative plantar flexion(18.9±5.1)°and dorsiflexion(14.1±5.2)°,and the difference was not statistically significant(P>0.05).Conclusion The use of yin-yang files to assist in the plastic and interstitial filling of the metatarsophalangeal joint for the treatment of this disease is minimally invasive,easy to operate,it reduces pain symptoms,preserves the shape and range of motion of the metatarsophalangeal joint,improves the patients'quality of life,and is a reliable treatment plan that is worthy of promotion and application.