第1跖骨近端推移截骨治疗中重度足母外翻△

Proximal first metatarsal lateral displacement osteotomy for moderate to severe hallux valgus

摘要:

[目的]探讨第 1 跖骨近端推移截骨治疗中重度足母外翻的临床疗效。[方法]2019 年 1 月—2023 年 3 月深圳第二人民医院采用近端推移截骨术治疗的 21 例中重度母外翻患者纳入本研究，其中男 2 例，女 19 例；平均（59.4±10.5）岁。评价临床及影像结果。[结果]所有患者均顺利完成手术。患者均获随访，随访时间平均（7.4±3.5）个月。与术前相比，末次随访时，患者 VAS 评分 [(2.7±0.8), (0.3±0.5), P＜0.001] 显著减少，AOFAS 评分 [(42.8±3.2), (94.0±2.7), P＜0.001] 显著增加。影像方面， 与术前相比，末次随访，母外翻角 （hallux valugs angle, HVA） [(40.5±7.4)°, (11.3±4.0)°, P＜0.001]、跖骨间角 （intermetatarsal an- lge, IMA） [(16.0±2.8)°, (6.7±3.2)°, P＜0.001]、跖骨远端关节固有角 （distal metatarsal articular angle, DMAA） [(17.3±9.4)°, (6.9± 4.0)°, P＜0.001] 均显著减小，籽骨 Handy-Clapham 分度显著改善 （P＜0.05），第 1 跖骨相对长度 （relative first metatarsal length, RML）无显著变化（P＞0.05）。[结论]第 1 跖骨近端推移截骨术能有效矫正母外翻畸形，改善患者临床症状。

关键词:母外翻;跖骨近端截骨术;第 1;2 跖骨间夹角;跖骨远端关节固定角

Abstract:

[Objective] To evaluate the short term clinical outcome of proximal first metatarsal lateral displacement osteotomy for the treatment of moderate to severe hallux valgus. [Methods] From January 2019 to March 2023, 21 patients with moderate to severe hallux valgus were treated by proximal displacement osteotomy in our hospital, including 2 males and 19 females aged (59.4±10.5) years on an average. The clinical and imaging data were evaluated. [Results] All patients were operated on successfully, and were followed up for an average of (7.4±3.5) months. Compared with those preoperatively, the VAS scores [(2.7±0.8), (0.3±0.5), P＜0.001] significantly reduced, while AOFAS score [(42.8±3.2), (94.0±2.7), P＜0.001] significantly increased at the latest follow-up. In terms of imaging, the hallux valugs angle (HVA) [(40.5±7.4)°, (11.3±4.0)°, P＜0.001], intermetatarsal anlge (IMA) [(16.0±2.8)°, (6.7±3.2)°, P＜0.001] significantly decreased, whereas the distal metatarsal articular angle (DMAA) [(17.3±9.4)°, (6.9±4.0)°, P＜0.001], Handy-Clapham scale of sesamoid bone significantly improved (P＜0.05), despite of that the relative first metatarsal length (RML) remained unchanged (P＞0.05). [Conclusion] The first proximal metatarsal displacement osteotomy does effectively correct valgus deformity and improve the clinical symptoms of patients.

Key words:hallux valgus; proximal metatarsal osteotomy; 1st and 2nd intermetatarsal angle; distal metatarsal articular angle