| 改良Lapidus截骨术第1跖楔关节单平面截骨联合第1跖骨下移治疗拇外翻的疗效分析 |
| Analysis of the efficacy of the modified Lapidus arthrodesis with single planar osteotomy of the first metatarsocuneiform joint combined with moving down the first metatarsal for the treatment of hallux valgus |
| 投稿时间：2022-11-28 |
| DOI：10.3969/j.issn.1672-5972.2024.03.010 |
| 中文关键词: 第1跖楔关节 拇外翻 Lapidus术 单平面截骨 |
| 英文关键词:First metatarsocuneiform joint Hallux valgus Lapidus arthrodesis Single planar osteotomy |
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| 中文摘要: |
| 目的 分析第1跖楔关节单平面截骨联合第1跖骨下移在改良Lapidus术中治疗拇外翻的疗效。方法 选取2018年9月至2021年9月在承德市中心医院采用改良Lapidus截骨术治疗的中重度拇外翻患者共27例（34足）。所有患者均拍摄术前负重X线、术后1周非负重X线和术后随访足负重位X线，测量第1跖骨长度（first metatarsal length, FML），拇外翻角（hallux valgus angle, HVA），第1、2跖骨间夹角（intermetatarsal angle, IMA），胫侧籽骨位置（tibial sesamoid position, TSP），第1跖骨基底距离地面高度和第1跖骨与地面角度，并根据美国足踝外科学会前足评分量表（American Orthopedics Foot and Ankle Society, AOFAS）与疼痛视觉评分（visual analogue scale, VAS）评价该术式的临床疗效。对以上收集的数据进行统计分析。结果 所有患者手术均顺利完成并获得12 ～ 48个月的随访，平均（23.71±8.05）个月。在FML方面，术后1周、末次随访与术前相比无明显变化，差异均无统计学意义（P＞0.05）。在HVA、IMA及TSP方面，术后1周、末次随访与术前相比减小，差异均有统计学意义（P＜0.05）；但术后1周与末次随访比较无明显变化，差异无统计学意义（P＞0.05）。在第1跖骨基底距离地面高度、第1跖骨与地面角度及VAS评分方面，末次随访时与术前相比减小，差异具统计学意义（P＜0.05）；在AOFAS评分方面，末次随访与术前相比增加，差异具有统计学意义（P＜0.05）。所有患者无转移性疼痛等并发症，部分患者表现为影像学资料角度增加。结论 第1跖楔关节单平面截骨联合第1跖骨下移不仅能够保证手术治疗效果，还可以有效预防传统Lapidus双平面截骨并发第1跖骨短缩及成角加大引起术后疼痛等并发症，是一种值得推广的手术方式。 |
| 英文摘要: |
| Objective To analyze the effect of the modified Lapidus arthrodesis with single planar osteotomy of the tarsometatarsal joint combined with first metatarsal inferior displacement for hallux valgus.Methods A total of 27 patients (34 feet) with moderate to severe hallux valgus who received modified Lapidus arthrodesis from September 2018 to September 2021 were selected at Chengde Center Hospital. All patients underwent preoperative weighted radiographs, 1 week postoperative unweighted radiographs, and follow-up foot weighted radiographs to measure the first metatarsal length (FML), the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the tibial sesamoid position (TSP), the height of the base of the 1st metatarsal from the ground and the angle of the 1st metatarsal and the ground. The clinical efficacy of the operation was evaluated according to the American Orthopedics Foot and Ankle Society (AOFAS) and visual analogue scale(VAS). Statistical analysis was performed on the above data.Results All patients underwent successful surgery and were followed up for 12 to 48 months. There was no significant difference in FML at the first week after surgery, at the last follow-up and before surgery (P>0.05). For HVA, IMA and TSP, there was a decrease at 1 week after surgery and at the last follow-up compared to before surgery, the differences were statistically significant (P<0.05), but there was no significant change between 1 week after surgery and the last follow-up (P>0.05). In terms of the height of the first metatarsal base from the ground,the angle between the first metatarsal and the ground and the VAS score, the last follow-up was lower than that before surgery, and the differences were statistically significant (P<0.05). For the AOFAS score, the last follow-up was higher than that before surgery, and the difference was statistically significant (P<0.05). All patients had no complications such as metastatic pain, and some patients showed increased imaging angles.Conclusion The single plane osteotomy of the first metatarsal wedge joint combined with the descending of the first metatarsal bone can not only guarantee the effect of surgical treatment, but also effectively prevent the postoperative pain and other complications caused by the shortening and angulation of the first metatarsal bone caused by the traditional Lapidus double plane osteotomy, which is worth promoting. |
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