温氏微创截骨手法整复术治疗重度拇外翻回顾性研究
摘要
目的：观察温氏微创截骨手法整复术治疗重度拇外翻的临床疗效。
方法：对望京医院关节二科2007年1月-2011年1月住院行温氏微创截骨手法整复术治疗的重度拇外翻患者进行术后随访,随访时摄足负重正侧位X线片,其中66例(103足)随访10个月以上,术前及术后资料完整。回顾性分析手术前后各足情况,行术前及术后拇趾-跖趾-趾间关节AOFAS评分,测量第一跖趾关节活动度,在手术前、后X线片上测量HAV角(拇外翻角)、IM角(第一、二跖骨间角)、TSP(胫侧籽骨位置)并进行比较。将术前及术后评分、相关解剖角度、第一跖趾关节活动度及胫侧籽骨位置进行统计学分析。所得数据应用SPSS16.0统计软件包分析处理,进行配对t检验及两配对样本的非参数检验,探讨温氏微创截骨手法整复术治疗重度拇外翻的实际疗效。
结果：本组随访时间为10—31个月,平均随访时间14.61个月,患者年龄19-75岁,平均56.55岁；左足55例,占53.40%；右足48例,占46.60%；37人双足,29人单足；男性2例4足,占3.88%；女性64例99足,占96.12%。
HAV角术前为：43.43°±6.00°,术后为：16.85°±6.59°,两者比较,平均减少26.58°,p<0.01,差异有统计学意义；
IM角术前：13.88°±3.18°,术后：7.94°±2.88°两者比较,平均减少5.94°,p<0.01,差异有统计学意义；
TSP术前为：6.50±0.85,术后为：3.70±0.96两者比较,平均减少2.80,p<0.01,差异有统计学意义；
第一跖趾关节活动度术前为：63.16°±18.70°,术后为62.60°±12.41°,两者比较,术后比术前平均减少0.56°,p=0.21,无明显差异；
术前AOFAS评分为：48.00±14.14分,术后为：90.51±6.77分两者比较,平均增加分42.51分,p<0.01,差异有统计学意义；
随访共66例(103足),术前前足底疼痛73足,占70.87%,术后前足底疼痛62足,术后消失11足(10.68%),无术前前足底无疼痛术后出现疼痛者,术后疼痛较术前疼痛加重4足(3.83%),减轻29足(28.16%),转移性跖骨痛发生率较低。
结论：本组病例术后拇外翻角度有所纠正,胫侧籽骨位置改善,AOFAS评分提高,第一跖趾关节活动度改变不明显,充分证明温氏微创截骨术治疗重度拇外翻有显著疗效。
Objective:To investigate the clinical effects of the treatment of severe hallux valgus with Wen's procedure(minimal incision osteotomy).
Method:The method used in our study is retrospectively analysis for the severe hallux valgus patients since Jan2007to Jan2011. Wen's procedure operation has been performed in the2nd joint department of Wangjing Hospital, and66cases (103feet) were followed up for more than10months. We followed up by Anterior-Posterior and lateral weight-bearing X-ray of feet at before and after opertation, and we have completely preoperative and postoperative data, included HAV (hallux valgus angle), IM angle (the Is'and2nd inter-metatarsal angle), AOFAS score, ROM of Is1MTPJ (metatarsophalangeal joint) and TSP(The tibial sesamoid position), which were retrospectively and statistically analyzed. The data used paired t-test and non-parametric test of two paired samples by SPSS16.0for analysis and processing,so as to discuss the actual efficacy of the Wen's Procedure to treat severe hallux valgus.
Results:The follow-up was performed on66patients, ranging from10months to31months, mean14.61months. Between19to75years of age, average was56.55years old; left foot55cases, accounting for53.40%; right foot48cases, accounting for46.60%;37patients with both feet,29patients with only one foot;2males(4feet), accounting for3.88%; female64casesa (99feet), accounting for96.12%.
The results of our study showed that the HAV Angle reduced mean26.58°after operation(43.43°±6.00°to16.85°±6.59°); the IM Angle reduced mean5.94°(13.88°±3.18°to7.94°±2.88°); TSP reduced mean2.80(6.50°0.85to3.70±0.96); The score of AOFAS increased mean42.51(48.00±14.14to90.51±6.77), both of these data have been statistically analyzed, then there are statistical ly significant differences for the significance level of p<0.01. The ROM of lstMTPJ change from63.16°±18.70°to62.60°±12.41°, reduced mean0.56°after operation, so it showed no significant difference (p=0.21). Follow-up66cases (103feet),73feet have fore-foot pain before surgery, accounting for70.87%,62feet have fore-foot pain after surgery, it have no pain inll foot (10.68%), have no patients who have not pain before and suffer pain after operation, but pain aggravated in4feet (3.83%), and reduce in29foot (28.16%), lower incidence of metastatic metatarsal pain. Conclusion:In conclusion, we state that Wen's Procedure for severe hallux valgus has significant clinical effects, because of HAV angle and IM angle reduced, TSP improved, the AOFAS score increased, the ROM of1st MTPJ change is not obvious after opteration in our study.
方法：对望京医院关节二科2007年1月-2011年1月住院行温氏微创截骨手法整复术治疗的重度拇外翻患者进行术后随访,随访时摄足负重正侧位X线片,其中66例(103足)随访10个月以上,术前及术后资料完整。回顾性分析手术前后各足情况,行术前及术后拇趾-跖趾-趾间关节AOFAS评分,测量第一跖趾关节活动度,在手术前、后X线片上测量HAV角(拇外翻角)、IM角(第一、二跖骨间角)、TSP(胫侧籽骨位置)并进行比较。将术前及术后评分、相关解剖角度、第一跖趾关节活动度及胫侧籽骨位置进行统计学分析。所得数据应用SPSS16.0统计软件包分析处理,进行配对t检验及两配对样本的非参数检验,探讨温氏微创截骨手法整复术治疗重度拇外翻的实际疗效。
结果：本组随访时间为10—31个月,平均随访时间14.61个月,患者年龄19-75岁,平均56.55岁；左足55例,占53.40%；右足48例,占46.60%；37人双足,29人单足；男性2例4足,占3.88%；女性64例99足,占96.12%。
HAV角术前为：43.43°±6.00°,术后为：16.85°±6.59°,两者比较,平均减少26.58°,p<0.01,差异有统计学意义；
IM角术前：13.88°±3.18°,术后：7.94°±2.88°两者比较,平均减少5.94°,p<0.01,差异有统计学意义；
TSP术前为：6.50±0.85,术后为：3.70±0.96两者比较,平均减少2.80,p<0.01,差异有统计学意义；
第一跖趾关节活动度术前为：63.16°±18.70°,术后为62.60°±12.41°,两者比较,术后比术前平均减少0.56°,p=0.21,无明显差异；
术前AOFAS评分为：48.00±14.14分,术后为：90.51±6.77分两者比较,平均增加分42.51分,p<0.01,差异有统计学意义；
随访共66例(103足),术前前足底疼痛73足,占70.87%,术后前足底疼痛62足,术后消失11足(10.68%),无术前前足底无疼痛术后出现疼痛者,术后疼痛较术前疼痛加重4足(3.83%),减轻29足(28.16%),转移性跖骨痛发生率较低。
结论：本组病例术后拇外翻角度有所纠正,胫侧籽骨位置改善,AOFAS评分提高,第一跖趾关节活动度改变不明显,充分证明温氏微创截骨术治疗重度拇外翻有显著疗效。
Objective:To investigate the clinical effects of the treatment of severe hallux valgus with Wen's procedure(minimal incision osteotomy).
Method:The method used in our study is retrospectively analysis for the severe hallux valgus patients since Jan2007to Jan2011. Wen's procedure operation has been performed in the2nd joint department of Wangjing Hospital, and66cases (103feet) were followed up for more than10months. We followed up by Anterior-Posterior and lateral weight-bearing X-ray of feet at before and after opertation, and we have completely preoperative and postoperative data, included HAV (hallux valgus angle), IM angle (the Is'and2nd inter-metatarsal angle), AOFAS score, ROM of Is1MTPJ (metatarsophalangeal joint) and TSP(The tibial sesamoid position), which were retrospectively and statistically analyzed. The data used paired t-test and non-parametric test of two paired samples by SPSS16.0for analysis and processing,so as to discuss the actual efficacy of the Wen's Procedure to treat severe hallux valgus.
Results:The follow-up was performed on66patients, ranging from10months to31months, mean14.61months. Between19to75years of age, average was56.55years old; left foot55cases, accounting for53.40%; right foot48cases, accounting for46.60%;37patients with both feet,29patients with only one foot;2males(4feet), accounting for3.88%; female64casesa (99feet), accounting for96.12%.
The results of our study showed that the HAV Angle reduced mean26.58°after operation(43.43°±6.00°to16.85°±6.59°); the IM Angle reduced mean5.94°(13.88°±3.18°to7.94°±2.88°); TSP reduced mean2.80(6.50°0.85to3.70±0.96); The score of AOFAS increased mean42.51(48.00±14.14to90.51±6.77), both of these data have been statistically analyzed, then there are statistical ly significant differences for the significance level of p<0.01. The ROM of lstMTPJ change from63.16°±18.70°to62.60°±12.41°, reduced mean0.56°after operation, so it showed no significant difference (p=0.21). Follow-up66cases (103feet),73feet have fore-foot pain before surgery, accounting for70.87%,62feet have fore-foot pain after surgery, it have no pain inll foot (10.68%), have no patients who have not pain before and suffer pain after operation, but pain aggravated in4feet (3.83%), and reduce in29foot (28.16%), lower incidence of metastatic metatarsal pain. Conclusion:In conclusion, we state that Wen's Procedure for severe hallux valgus has significant clinical effects, because of HAV angle and IM angle reduced, TSP improved, the AOFAS score increased, the ROM of1st MTPJ change is not obvious after opteration in our study.
引文
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