Scarf截骨可吸收螺钉内固定联合改良McBride术治疗中重度拇外翻

Scarf osteotomy with absorbable screw internal fixation combined with modified McBride procedure for the treatment of moderate to severe hallux valgus

目的 探讨Scarf截骨可吸收螺钉内固定联合改良McBride术治疗中重度拇外翻的临床疗效。方法 选取2017年6月至2023年2月住院治疗的中重度拇外翻患者50例(60足)。其中,中度拇外翻30例(35足)、重度拇外翻20例(25足),均予以Scarf截骨可吸收螺钉内固定联合改良McBride术治疗。记录术前及术后16周测量拇外翻角(hallux valgus angle, HVA),第1、2跖骨间夹角(intermetatarsals angle, IMA),第1跖骨远端关节面固有角(distal metatarsal articular angle, DMAA)及根据AOFAS评分标准评价疗效。结果 全部患者术后均获随访,随访时间6~12个月,平均8.26个月。60足负重位术后16周X线片示HVA、IMA、DMAA均小于术前(P<0.05)。截骨处均骨性愈合,愈合时间4~5个月,无延迟愈合、骨不连和跖骨头坏死发生,有4例患者发生并发症,其中1足出现转移性跖骨痛,1足内侧切口边缘皮肤感觉麻木,2足遗留第1跖趾关节僵硬,无复发病例。术后16周随访参照AOFAS评分标准评价疗效:优53足、良4足、可2足、差1足,优良率为95.0%,术后16周AOFAS评分高于术前(P<0.05)。结论 Scarf截骨可吸收螺钉内固定联合改良McBride术治疗中重度拇外翻能有效矫正畸形、缓解疼痛、恢复前足功能,疗效优良,值得临床推广。

Objective To evaluate the clinical efficacy of Scarf osteotomy with internal fixation by absorbable screws combined with the modified McBride procedure in the treatment of moderate to severe hallux valgus.Methods Fifty patients(60 feet)with moderate to severe hallux valgus hospitalised between June 2017 and February 2023 were selected,including 30 patients(35 feet)with moderate hallux valgus and 20 patients(25 feet)with severe hallux valgus.All patients were treated with Scarf osteotomy and internal fixation with absorbable screws combined with modified McBride surgery.The hallux valgus angle(HVA),intermetatarsal angle(IMA)and distal metatarsal articular angle(DMAA)were measured before surgery and 16 weeks after surgery.The therapeutic effect was evaluated based on the changes in the above three angles before and after surgery and the AOFAS scoring standard.Results All patients were followed up for 6-12 months(average 8.26 months)after surgery.The HVA,IMA and DMAA shown on X-ray films of 60 feet at 16 weeks after surgery were lower than those before surgery(P<0.05).All osteotomy sites healed with a healing time of 4-5 months.There was no delayed healing,no bone union,or necrosis of the metatarsal head.Four patients developed complications,including metatarsal pain in one foot,numbness of the skin at the edge of the medial incision in one foot,and stiffness of the first metatarsophalangeal joint in two feet.There were no relapses.Efficacy was assessed using the AOFAS scoring standard at 16 weeks after surgery:53 feet were excellent,4 feet were good,2 feet were fair and 1 foot was poor.The excellent and good rates were 95.0%.The AOFAS score at 16 weeks postoperatively was higher than the preoperative score(P<0.05).Conclusion Scarf osteotomy with internal fixation by absorbable screws combined with the modified McBride procedure for the treatment of moderate to severe hallux valgus can effectively correct deformity,relieve pain and restore forefoot function.The therapeutic effect is excellent and worthy of clinical promotion.