中西医结合微创技术治疗拇趾外翻诊疗规范化研究
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摘要
1研究背景
拇趾外翻(HAV)是常见的足部畸形。主要发生在14～70岁的女性,男女比例为1:20。临床表现主要为前足畸形及疼痛,穿鞋行走受限,严重地影响患者的生活质量。拇趾外翻中医无此病名,但可归于筋伤的“骨离缝、筋出槽”或痹症的范畴。中医理论认为:肾主骨生髓,老年人,尤其是形盛体衰,肝肾不足者,筋骨衰弱,长期劳损,均可致骨失筋束而发为外翻畸形。拇外翻的早、中期单纯出现拇趾外翻畸形,尚未引起其他病变,只是筋偏于正常解剖位置,故属于筋走、筋歪;若后期拇趾内侧疼痛,或伴有足底疼痛、其他畸形,足部行走受限,足趾关节屈伸不利者,应归为痹症。拇趾外翻发生的主要病因、病理机制:西医认为①生物力学性②关节炎性③神经肌肉性④创伤性。导师温建民教授提出的观点:病因为①内因主要与年龄、体质、解剖结构及先天发育畸形等有关;②外因主要有急性创伤、慢性劳损、风寒湿邪侵袭等。病机为①拇趾外翻的发生发展存在阴阳失衡,即内、外、背、跖的肌腱肌力阴阳失衡。②拇外翻的发生发展存在“骨离缝、筋出槽”的病理机制。
拇趾外翻传统矫治方法很多,达200多种,归纳为六类:①拇囊肿切除术及软组织手术;②第一跖趾关节成形术;③第一跖骨头颈干截骨术;④跖骨基底截骨术;⑤特殊手术;⑥拇趾人工假体置换术。传统手术,大切口,软组织损伤大,需要内固定及石膏外固定,病人痛苦大,恢复慢,术后下地晚,复发率高,可出现跖骨头下疼痛等并发症。二十世纪八十年代末至今,导师温建民教授在总结国内外治疗拇趾外翻经验的基础上,结合中医整复骨折畸形的手法、小夹板纸压垫原理及中药治疗骨折的经验,创立了中西医结合微创技术治疗拇趾外翻新方法。针对拇外翻的病因和病理同时进行了处理,取得了较好的疗效。多次获得省、部、国家级奖项。并在全国各地推广,治愈拇趾外翻患者达2万余人。本疗法术式简便,矫形满意,畸形少复发,术后少痛,无需内固定,术后下地早,恢复快,并发症少,是目前治疗拇趾外翻最佳方法。
但是,此项技术在推广过程中存在一些认识和操作上的误区,以致影响手术疗效。为了提高拇趾外翻的中西医结合治疗水平,进一步推广此项新技术,造福广大拇趾外翻患者,本课题组制定了规范化的临床诊断标准、分型标准、规范化的操作流程、规范化的术后康复及疗效评价体系。为了阐述及验证规范化的中西医结合微创技术治疗拇趾外翻诊疗体系的科学性,我们采用多中心、自身前后对照的研究方法对4家分中心200足拇外翻临床疗效进行比较。其中包括①回顾性研究;②中西医结合微创技术治疗拇趾外翻诊疗规范化研究(规范化研究;规范化方案多中心研究;规范化方案与传统大切口对照研究)③解剖学研究。
2回顾性研究
2.1研究目的:
肯定中西医结合微创技术治疗拇趾外翻的疗效,并寻找不足。
2.2材料与方法
对1996～1999年150足79例拇外翻,按照手术前后自身对照的方法进行对比,观察分析HAV、IM等指标,采用新的疗效评价标准(AOFAS与既往导师温建民教授提出的疗效评价标准相结合),通过统计学处理对数据进行分析,研究该治疗方法的有效性。
2.3结果
2.3.1中西医结合微创技术治疗拇外翻经临床验证,疗效肯定,优良率92%。
中西医结合微创技术治疗拇外翻能很好地矫正HAV、IM、第Ⅰ-Ⅱ跖骨头间距及TSP等观察指标(P＜0.01)。第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)术后改善了91.8%。优良率92%。证明中西医结合微创技术治疗拇外翻畸形有效。
2.3.2中西医结合微创技术治疗拇外翻规范化的迫切性
2.3.2.1回顾性研究发现的不足:
①术后拇内翻2足(1.3%)。分析本组出现拇内翻的原因为:1矫枉过正;2术后缺乏定期复查和及时纠正。
②术后残留轻、中度拇外翻40足(26.7%),分析其原因:1病人拇外翻严重,既往有脑血管意外;2外侧关节囊挛缩,内收肌紧张;3不同程度的拇外翻足均采用同一手术术式进行矫正,缺乏个体化治疗,结果不甚满意。
③术区麻木4足(2.7%)。拇趾内侧有腓深神经分支在皮下走行,可伤及。
④术后第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)无改善(或加重)8足,占术前总胼胝体(胼胝痛)的8.2%,占总组病例的5.3%。为畸形纠正不彻底所致。
2.3.2.2中西医结合微创技术治疗拇外翻在基层推广过程中出现的问题:
①第一跖趾关节内侧骨赘削磨过多致跖趾关节吻合差,远端跖骨块失稳(向跖侧及外侧成角)致拇内翻。
②截骨方向及截骨角度不适宜致矫枉过正或矫正不彻底。
③功能锻炼不足,拇趾活动受限或部分受限。
④术中损伤血管致足趾坏死;损伤神经致足趾皮肤麻木。
2.4结论
2.4.1中西医结合微创技术治疗拇外翻疗效肯定,优良率92%。
2.4.2中西医结合微创技术治疗拇外翻诊疗体系规范化至关重要。
3中西医结合微创技术治疗拇外翻规范化研究
3.1研究目的:
①鉴于中西医结合微创技术治疗拇外翻现存的问题,本课题组制定了规范化的临床诊断标准、分型标准、规范化的操作流程、规范化的术后康复及疗效评价方案。以利于提高拇趾外翻的中西医结合治疗水平,进一步推广此项新技术,造福广大拇趾外翻患者。
②阐述及验证规范化的中西医结合微创技术治疗拇外翻诊疗方案的科学性。
3.2材料与方法
对2006～2007年200足拇外翻进行研究,其中①对170足拇外翻(望京医院110足;电力医院30足;广安门医院30足)采用规范化方案,按已制订的规范化流程进行分型及治疗,并采用多中心、自身前后对照的方法进行对比;②对30足拇外翻(冶金医院30足)采用传统大切口,按已成熟的手术技术(Austin17足、Mitchel13足)进行治疗,并采用规范化方案(望京医院30足)与传统大切口对照的方法进行研究。观察HAV、IM、AOFAS等10项指标,采用新的疗效评价标准(AOFAS与既往导师温建民教授提出的疗效评价标准相结合),并通过统计学处理对数据进行分析,研究并验证该规范化的中西医结合微创技术治疗拇趾外翻诊疗方案的有效性、科学性及其在推广应用中的可行性。
3.3结果
3.3.1规范化的中西医结合微创技术治疗拇趾外翻诊疗方案经临床验证,效果显著。优良率99.1%,与未规范化的方案(回顾性研究)比,得到了明显提高,优良率提高了7.1%。
对110足拇外翻(望京医院)采用规范化诊疗方案进行分组及治疗,并通过自身前后对照的方法进行研究。手术前后大多数观察指标比较,差异有显著性(P＜0.01)。术后矫正HAV角平均21.03°±2.00°(其中轻度组矫正HAV 16.05°±0.49°;中度组矫正HAV20.79°±3.67°;重度组矫正HAV25.98°±0.31°);矫正IM角平均4.69°±0.19°(其中轻度组矫正IM 2.39°±0.24°;中度组矫正IM 4.31°±1.17°;重度组矫正IM 7.26°±1.25°);AOFAS评分术后平均提高31.52±11.01分(其中轻度组AOFAS提高30.62±10.73分;中度组AOFAS提高31.18±10.45分;重度组AOFAS提高32.75±12.34分);TSP术后平均纠正2.74±0.22(其中轻度组TSP矫正2.48±0.37;中度组TSP矫正2.70±0.14;重度组TSP矫正3.06±0.01)。证明了该规范化方案疗效显著,优良率99.1%。规范化方案针对各种程度的拇外翻足,采用个体化治疗,有效地纠正了HAV、IM等观察指标,大大地提高了优良率,优良率99.1%,与未规范化的方案(回顾性研究)比,优良率提高了7.1%。
3.3.2规范化的中西医结合微创技术治疗拇趾外翻诊疗方案在望京医院、电力医院及广安门医院三家分中心推广应用,经临床验证,疗效肯定、可靠,易于推广。优良率分别为96.7%(望京医院),93.3%(电力医院),93.3%(广安门医院)。
对90足拇外翻(望京医院30足;电力医院30足;广安门医院30足)采用规范化方案进行分型及治疗,并通过多中心、自身前后对照的方法进行研究。①该技术能很好地纠正HAV、IM、TSP、AOFAS等(P＜0.01),患者满意。验证了该规范化的诊疗方案在三家分中心推广应用疗效确定,优良率分别为96.7%(望京医院),93.3%(电力医院、广安门医院)。②三家分中心手术前后各项观察指标差值比较,均P＞0.05,说明了该规范化方案在三家分中心应用疗效肯定、可靠,易于推广。
3.3.3望京医院及冶金医院两家分中心分别采用规范化方案及传统大切口两种方法治疗拇趾外翻,经临床证实,疗效确定,优良率均为96.7%(望京医院、冶金医院);规范化方案优于传统大切口技术。
对60足拇外翻(望京医院30足;冶金医院30足)分别采用规范化方案及传统大切口进行诊疗并通过多中心、自身前后对照的方法进行研究。①验证了规范化方案治疗拇外翻可以获得同大切口技术相同的疗效(两家分中心各项观察指标手术前后比较,均P＜0.01;各项观察指标手术前后差值比较,均P＞0.05),望京医院与冶金医院优良率均为96.7%。②规范化方案优于大切口技术:术后拇内翻、拇外翻、术区足趾麻木、足部肿胀时间及术后第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)的发生,望京医院均较冶金医院少,原因在于1规范化系统损伤小2诊疗规范化。中药内服外用,活血化瘀、消肿止痛、补肾壮骨。传统大切口术式具有切口7～10cm,腰麻,缝合,需要内固定、止血带、二次手术,术后下地时间长,损伤大等特点,病人难以接受。而微创技术切口小于1cm,局麻,无需缝合、内固定、止血带及二次手术,损伤小,术后即可下地走路,深受广大患者欢迎。
3.4结论
通过对200足拇外翻采用多中心、自身前后对照的方法进行研究,经临床验证,证实了规范化的中西医结合微创技术治疗拇趾外翻诊疗方案疗效显著;在分中心推广应用疗效确定、可靠,易于推广;规范化的中西医结合诊疗方案治疗拇外翻可获得同传统大切口技术相同的疗效,且优于传统大切口技术。
4解剖学研究
4.1研究目的:
①了解中西医结合治疗拇外翻微创技术对足部解剖结构的影响②明确手术关键操作与周围血管、神经的位置关系③完善中西医结合治疗拇外翻的微创操作技术④研究并验证手术操作的安全性。
4.2材料与方法
解剖福尔马林溶液浸泡足6只(正常足4只;拇外翻足2只),研究并验证手术操作的安全性。
4.3结果
通过解剖福尔马林溶液浸泡足6只,结合文献及解剖图谱,验证了手术操作的安全性。
①外侧结构松解,不会损伤拇趾腓侧跖背动脉及跖底动脉,不会损伤拇内收肌在近节趾骨基底的止点,不会损伤腓深神经。
②第一跖骨头颈截骨,不会损伤拇长、短伸、屈肌腱及拇展肌肌腱,可能伤及足背内侧皮神经的分支及大隐静脉在拇趾背内侧的分支,因足部有丰富的静脉网代偿,故而截骨是安全的。
③通过截骨远端外移,初步恢复了跖籽系统与第一跖骨头的正常解剖关系。
4.4结论
通过解剖学研究证实了该规范化方案是安全的、可行的。
5本课题的创新点
①创立一套规范化的中西医结合微创技术治疗拇趾外翻的诊断、分型、治疗、康复及疗效评估体系。
②首次将多中心、自身前后对照的方法应用于中西医结合微创技术治疗拇趾外翻的研究中。
1A research background
Hallux valgus(HAV) is a common foot deformities.Mainly occurred in the 14 to 70-year-old female,male to female ratio was 1:20.The main clinical manifestations of the former deformity and pain,limited walking shoes,seriously affecting the quality of life of patients.Hallux valgus Chinese Name absence,but tendon injuries can be attributed to the "bone from the joint,the tendons trough" or arthralgia syndrome areas.Chinese medicine theory:Kidney Health main bone marrow,and feeble-Shing,liver and kidney inadequate,their debilitating,long-term fatigue,bone loss can be caused by the reinforcement beam and the hallux valgus deformity.Hallux valgus the early and mid-simply a Hallux valgus deformity,yet lead to other diseases, but the normal anatomy of tendons biased position,it is taking tendons,tendon distortion;if the latter part of the medial toe pain,or pain associated with plantar,and other abnormalities,limited walking foot and toe joint flexion and extension disadvantaged,shall be vested in the arthralgia syndrome.Hallux valgus pathological mechanism of the main events:Western medicine think of that①biomechanics②arthritis③neuromuscular of④traumatic.Tutor-Jianmin to the point made by Professor①Hallux valgus exist in the development of yin and yang balance,that is, inside and outside,back,the plantaris muscle tendon imbalance of yin and yang.②hallux valgus exist in the development "from the bone joints,tendons a trough" pathological mechanism.
There are many ways to traditional treatment to Hallux valgus more than 200, into six categories:①thumb cyst resection and soft tissue surgery;②the first metatarsophalangeal joint angioplasty;③osteotomy of the first metatarsal head and neck of the stem;④plantar Bone basement osteotomy;⑤special operation;⑥toe Prosthetic replacement.Traditional surgery,large incision,soft tissue injury,the need for fixed and fixed plaster,the patient suffering,recovered slowly after Shimoji late, high recurrence rate,there will be pain under the metatarsal head and other complications.20 since the end of the 1980s,mentor,Professor Wen Jianmin treated Hallux valgus at home and abroad and concluded on the basis of experience with complex fracture of the entire Chinese medicine approach,small splint pressure pad of paper Principle and the experience of Chinese medicine treatment of fractures, created the Integrated Treatment of Hallux valgus,renovation methods.Hallux valgus against the etiology and pathology at the same time dealing with,and achieved good results.Won many provinces,ministries,state-level awards.And promotion throughout the country,Hallux valgus patients cured of 2 million people.This treatment method is simple,orthopaedic satisfied with less recurrence of deformity, less postoperative pain,without internal fixation after Shimoji early,rapid recovery, fewer complications,is the best way for Hallux valgus.
However,in the promotion of the technology in the course of some of the awareness and operational errors,thus affecting surgical treatment.In order to improve Hallux valgus in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients,the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization postoperative rehabilitation and efficacy evaluation system.To describe the standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the system of clinics,we have adopted a multi-center, and self-control before and after,standardization programmes compared with the traditional large incision research methods to four Centre at 200 hallux valgus feet Clinical comparison.Including①A retrospective study;②Integrated Treatment of Hallux valgus standardization of treatment(standardized research programme、standardized multi-center study programme with the traditional standardized large incision control study)③Anatomical study.
2 A retrospective study
2.1 Purpose of the study:
Integrative Medicine will be confirmed excellently in the treatment of hallux valgus,and find inadequate.
2.2 Materials and Methods
1996 to 1999 of 150 feet 79 cases of hallux valgus,in accordance with their own before and after contrast control methods,observing and analyzing HAV,IM,and other indicators,the effect of the introduction of the new evaluation criteria,through SPSS13.0 statistical software for data analysis to study the effectiveness of the treatment method.
2.3 Results
2.3.1 Integrated Treatment of hallux valgus was verificated by clinics,effective, excellent rate 92%.
Integrated Treatment of hallux valgus correction can be good of HAV,IM,Ⅰ-Ⅱmetatarsal head distance and TSP,and other parameters(P＜0.01).Ⅱ、Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) after a 91.8% improvement.Excellent rate is 92%.Proof of integrative medicine verificated effectively treatment of hallux valgus deformity.
2.3.2 The urgency of the standardization of integrated Treatment of hallux valgus
2.3.2.1 Insufficients founded from retrospective study:
①Thumb varus after 2 feet(1.3 per cent).Analysis of this group in the thumb inversion reasons:1 overkill;2 a lack of regular inspection and promptly corrected.
②Postoperative residual mild to moderate hallux valgus 40 feet(26.7%), analyzing the reasons:a serious patients hallux valgus,past a cerebrovascular accident;lateral joint capsule contracture,the hallux valgus feet of three different levels were using the same surgical procedure to correct,the lack of individualized treatment,the results are not quite satisfied.
③Numbness of the District 4 feet(2.7 per cent).Toe with the medial branch of the superficial peroneal nerve in the subcutaneous course,can be hurt.
④AfterⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) no improvement(or heavier) 8 feet of the former Chief of the corpus callosum (the corpus callosum pain) of 8.2 per cent of the total group to 5.3%of cases,it is caused by that deformities is not completely correct.
2.3.2.2 Issues emerging from the process of Integrated Treatment of hallux valgus promoted at the grassroots level:
①First metatarsophalangeal joint medial Osteophyte to cut excessive grinding metatarsophalangeal joint anastomosis poor,unstable distal metatarsal block(to the side and lateral plantar angle) of thumb inversion.
②Osteotomy direction and angle of an overkill or being not completely correct.
③Lack of exercise,restricted or part of the great toe activities restricted.
④Necrosis induced by vascular injury in the toe and skin anesthesia of numb toes induced by nerve damage.
2.4 Conclusion
2.4.1 Integrated Treatment of hallux valgus is effective,high rate of 92%.
2.4.2 Integrated Treatment ofhallux valgus clinics system standardization is essential.
3 Integrated Treatment of hallux valgus standardized research
3.1 Purpose of the study:
①In view of the Integrated Treatment of hallux valgus the existing problems, the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization of evaluation and postoperative rehabilitation programme.Hallux valgus benefit of the increase in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients.
②On standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the treatment programme.
3.2 Materials and Methods
2006～2007 200 feet hallux valgus study,which①hallux valgus of 170 feet (110 feet WanNing Hospital;electricity hospital 30 foot;Guang'An Men hospital 30 feet) using standardized programme has been developed by the standardization of processes Classification and treatment,and a multi-center,and self-control method before and after contrast②30 feet hallux valgus(Metallurgy Hospital 30 feet) using traditional large incision,according to the surgical technique maturing(Austin, Mitchel) treatment,and adopt standardized Programme(WanNing Hospital 30 feet) contrast with the traditional large incision approach.Observation HAV,IM,such as 10 AOFAS indicators,and through SPSS13.0 statistical software for data analysis, research and verify the standardization of Integrated Treatment of Hallux valgus clinics programme effectiveness in the promotion of science and the application of feasibility.
3.3 Results
3.3.1 Standardized Integrated Treatment of Hallux valgus clinics programme has been verificated by clinical test results significantly.Excellent rate of 99.1%,and non-standardized Programme(retrospective study) ratio has been remarkably improved,the excellent and good rate increased 7.1%.
110 feet hallux valgus(WanNing Hospital) using standardized clinics and treatment programmes for a division,and through its own method of comparing before and after the study.Most observed before and after surgery,the difference was significant(P＜0.01).HAV correction after an average of 21.03°±2.00°(HAV correction of mild group 16.05°±0.49°;moderate group Correction HAV 20.79°±3.67°;severe correction group HAV 25.98°±0.31°);IM angle correction average 4.69°±0.19°(correction mild group IM 2.39°±0.24°;Correction moderate group IM 4.31°±1.17°;severe group Correction IM 7.26°±1.25°); TSP after correcting average 2.74±0.22(TSP mild group correction 2.48±0.37; moderate group TSP Correction 2.70±0.14;severe group TSP Correction 3.06±0.01);AOFAS score after an average of 31.52±11.01 points(including mild group AOFAS increased 30.62±10.73 points;moderate group AOFAS raise 31.18±10.45 points;severe group AOFAS increased 32.75±12.34 points).Proved that the significant effect of standardization programme,the excellent and good rate 99.1%.3.3.2 Standardized Integrated Treatment of Hallux valgus in the clinics programme Wangjing Hospital,Guang'An Men hospitals and electricity Hospital three Center application,verified by clinical efficacy sure no difference. Excellent rates were 96.7%(Wangjing Hospital),93.3%(electricity Hospital), 93.3%(Guang'An Men Hospital).
Hallux valgus 90 feet(30 feet Wangjing Hospital;electricity hospital 30 foot; Guang'An Men hospital 30 feet) using standardized programme type and treatment, and through multi-center,and self-control method before and after the study.①well the technology can correct HAV,IM,TSP,AOFAS(P＜0.01),and patient satisfaction. Validity of the standardized treatment programmes in the three centers promote the use of identification,excellent rates were 96.7%(Wangjing Hospital),93.3% (electricity hospitals,Guang'An Men Hospital).②three centers before and after surgery compared the observed difference,P＞0.05,shows that the standardization programmes in the three sub-centre applications no difference in efficacy.
3.3.3 Wangjing Hospital and metallurgical hospital two centers were used standardized programmes and the traditional large incision two methods for Hallux valgus,the clinically proven efficacy determined that no difference, excellent rates of 96.7%(Wangjing Hospital,metallurgical hospitals); standardization programme is better than the traditional large incision technology.
Hallux valgus 60 feet(30 feet Wangjing Hospital;metallurgical hospital 30 feet) were used standardized programmes and the traditional large incision and clinics through a multi-center,and self-control method before and after the study.①a standardized test in the treatment of hallux valgus with the large incision can be the same technical effect(two centers of the observed before and after surgery,all P＜0.01;the observed difference compared before and after surgery,all P＞0.05), Wangjing Hospital and metallurgical hospitals are excellent rate 96.7%.②standardization programme is better than large incision technology:In thumb after varus,hallux valgus,the toe area of numbness,swelling of the foot time and postoperativeⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) occurred,Wangjing Hospital is less than Metallurgical hospitals,because of a standardized system injury two small clinics standardization.Chinese Herbs topical, Blood Circulation,swelling pain,Bushen Zhuanggu.Traditional large incision technique is 7-10 cm incision,spinal anesthesia,suture,the need for a fixed, tourniquet,the second surgery,go after a long time,the characteristics of the injury, poor compliance of patients.The minimally invasive technique is less than 1 cm incision,local anesthesia,no suture,internal fixation,tourniquet and secondary surgery,injury,after Shimoji can walk,welcomed by the overwhelming majority of patients,and good compliance.
3.4 Conclusion
Through 200 feet hallux valgus a multi-center,and self-control and the method of contrast studies of standardization programmes and the traditional large incision technology,by the clinical test,confirming that the standardization of integrated treatment of Hallux valgus programme of clinics significantly;Application at the centre of identification,and no difference in efficacy;standardized in Integrative Medicine clinic programme will be with traditional large incision of the same technology,and technology is superior to the traditional large incision.
4 Anatomical study
4.1 The purpose of the study:
①Understanding of combining traditional Chinese and western medicine treatment of hallux valgus minimally invasive technique of anatomical structure of the foot②Clear surgical operation and key peripheral vascular,neurological③Improve relations between the location of Integrated Treatment of the hallux valgus minimally invasive technique to study and verify④The safety of surgical operations.
4.2 Materials and Methods
Anatomy of formalin solution immersion foot six,research and verify the safety of surgical incision and release.
4.3 Results
Through anatomy of formalin solution immersion foot six,combining literature and anatomical map,the safety of surgical incision and release has been verified.
①Lateral structure release,not great toe injury fibular dorsal metatarsal artery and plantar artery,not the thumb injury to muscle in the basement near the toe section only,not deep peroneal nerve injury.
②Osteotomy of the first metatarsal head and neck,thumb injury will not be long,short stretch,the flexor tendon and muscle tendon thumb exhibition,may hurt the medial dorsal foot nerve and a branch of the saphenous vein in the great toe back inside the branch,Because of the foot is rich in compensatory vein network,therefore osteotomy is safe.
③Through the relocation of the distal osteotomy,the initial resumption of the first metatarsal seed system and the first metatarsal head of the anatomy of normal relations is true.
4.4 Conclusion
Anatomy analysis confirmed that the standardization programme is safe and feasible.
5 Topics innovation
①Creation of a standardized Integrated Treatment of Hallux valgus in the diagnosis,treatment,rehabilitation and efficacy evaluation system.
The first multi-center,and self-control before and after the method has been applied to Integrated Treatment of Hallux valgus in the study.
拇趾外翻(HAV)是常见的足部畸形。主要发生在14～70岁的女性,男女比例为1:20。临床表现主要为前足畸形及疼痛,穿鞋行走受限,严重地影响患者的生活质量。拇趾外翻中医无此病名,但可归于筋伤的“骨离缝、筋出槽”或痹症的范畴。中医理论认为:肾主骨生髓,老年人,尤其是形盛体衰,肝肾不足者,筋骨衰弱,长期劳损,均可致骨失筋束而发为外翻畸形。拇外翻的早、中期单纯出现拇趾外翻畸形,尚未引起其他病变,只是筋偏于正常解剖位置,故属于筋走、筋歪;若后期拇趾内侧疼痛,或伴有足底疼痛、其他畸形,足部行走受限,足趾关节屈伸不利者,应归为痹症。拇趾外翻发生的主要病因、病理机制:西医认为①生物力学性②关节炎性③神经肌肉性④创伤性。导师温建民教授提出的观点:病因为①内因主要与年龄、体质、解剖结构及先天发育畸形等有关;②外因主要有急性创伤、慢性劳损、风寒湿邪侵袭等。病机为①拇趾外翻的发生发展存在阴阳失衡,即内、外、背、跖的肌腱肌力阴阳失衡。②拇外翻的发生发展存在“骨离缝、筋出槽”的病理机制。
拇趾外翻传统矫治方法很多,达200多种,归纳为六类:①拇囊肿切除术及软组织手术;②第一跖趾关节成形术;③第一跖骨头颈干截骨术;④跖骨基底截骨术;⑤特殊手术;⑥拇趾人工假体置换术。传统手术,大切口,软组织损伤大,需要内固定及石膏外固定,病人痛苦大,恢复慢,术后下地晚,复发率高,可出现跖骨头下疼痛等并发症。二十世纪八十年代末至今,导师温建民教授在总结国内外治疗拇趾外翻经验的基础上,结合中医整复骨折畸形的手法、小夹板纸压垫原理及中药治疗骨折的经验,创立了中西医结合微创技术治疗拇趾外翻新方法。针对拇外翻的病因和病理同时进行了处理,取得了较好的疗效。多次获得省、部、国家级奖项。并在全国各地推广,治愈拇趾外翻患者达2万余人。本疗法术式简便,矫形满意,畸形少复发,术后少痛,无需内固定,术后下地早,恢复快,并发症少,是目前治疗拇趾外翻最佳方法。
但是,此项技术在推广过程中存在一些认识和操作上的误区,以致影响手术疗效。为了提高拇趾外翻的中西医结合治疗水平,进一步推广此项新技术,造福广大拇趾外翻患者,本课题组制定了规范化的临床诊断标准、分型标准、规范化的操作流程、规范化的术后康复及疗效评价体系。为了阐述及验证规范化的中西医结合微创技术治疗拇趾外翻诊疗体系的科学性,我们采用多中心、自身前后对照的研究方法对4家分中心200足拇外翻临床疗效进行比较。其中包括①回顾性研究;②中西医结合微创技术治疗拇趾外翻诊疗规范化研究(规范化研究;规范化方案多中心研究;规范化方案与传统大切口对照研究)③解剖学研究。
2回顾性研究
2.1研究目的:
肯定中西医结合微创技术治疗拇趾外翻的疗效,并寻找不足。
2.2材料与方法
对1996～1999年150足79例拇外翻,按照手术前后自身对照的方法进行对比,观察分析HAV、IM等指标,采用新的疗效评价标准(AOFAS与既往导师温建民教授提出的疗效评价标准相结合),通过统计学处理对数据进行分析,研究该治疗方法的有效性。
2.3结果
2.3.1中西医结合微创技术治疗拇外翻经临床验证,疗效肯定,优良率92%。
中西医结合微创技术治疗拇外翻能很好地矫正HAV、IM、第Ⅰ-Ⅱ跖骨头间距及TSP等观察指标(P＜0.01)。第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)术后改善了91.8%。优良率92%。证明中西医结合微创技术治疗拇外翻畸形有效。
2.3.2中西医结合微创技术治疗拇外翻规范化的迫切性
2.3.2.1回顾性研究发现的不足:
①术后拇内翻2足(1.3%)。分析本组出现拇内翻的原因为:1矫枉过正;2术后缺乏定期复查和及时纠正。
②术后残留轻、中度拇外翻40足(26.7%),分析其原因:1病人拇外翻严重,既往有脑血管意外;2外侧关节囊挛缩,内收肌紧张;3不同程度的拇外翻足均采用同一手术术式进行矫正,缺乏个体化治疗,结果不甚满意。
③术区麻木4足(2.7%)。拇趾内侧有腓深神经分支在皮下走行,可伤及。
④术后第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)无改善(或加重)8足,占术前总胼胝体(胼胝痛)的8.2%,占总组病例的5.3%。为畸形纠正不彻底所致。
2.3.2.2中西医结合微创技术治疗拇外翻在基层推广过程中出现的问题:
①第一跖趾关节内侧骨赘削磨过多致跖趾关节吻合差,远端跖骨块失稳(向跖侧及外侧成角)致拇内翻。
②截骨方向及截骨角度不适宜致矫枉过正或矫正不彻底。
③功能锻炼不足,拇趾活动受限或部分受限。
④术中损伤血管致足趾坏死;损伤神经致足趾皮肤麻木。
2.4结论
2.4.1中西医结合微创技术治疗拇外翻疗效肯定,优良率92%。
2.4.2中西医结合微创技术治疗拇外翻诊疗体系规范化至关重要。
3中西医结合微创技术治疗拇外翻规范化研究
3.1研究目的:
①鉴于中西医结合微创技术治疗拇外翻现存的问题,本课题组制定了规范化的临床诊断标准、分型标准、规范化的操作流程、规范化的术后康复及疗效评价方案。以利于提高拇趾外翻的中西医结合治疗水平,进一步推广此项新技术,造福广大拇趾外翻患者。
②阐述及验证规范化的中西医结合微创技术治疗拇外翻诊疗方案的科学性。
3.2材料与方法
对2006～2007年200足拇外翻进行研究,其中①对170足拇外翻(望京医院110足;电力医院30足;广安门医院30足)采用规范化方案,按已制订的规范化流程进行分型及治疗,并采用多中心、自身前后对照的方法进行对比;②对30足拇外翻(冶金医院30足)采用传统大切口,按已成熟的手术技术(Austin17足、Mitchel13足)进行治疗,并采用规范化方案(望京医院30足)与传统大切口对照的方法进行研究。观察HAV、IM、AOFAS等10项指标,采用新的疗效评价标准(AOFAS与既往导师温建民教授提出的疗效评价标准相结合),并通过统计学处理对数据进行分析,研究并验证该规范化的中西医结合微创技术治疗拇趾外翻诊疗方案的有效性、科学性及其在推广应用中的可行性。
3.3结果
3.3.1规范化的中西医结合微创技术治疗拇趾外翻诊疗方案经临床验证,效果显著。优良率99.1%,与未规范化的方案(回顾性研究)比,得到了明显提高,优良率提高了7.1%。
对110足拇外翻(望京医院)采用规范化诊疗方案进行分组及治疗,并通过自身前后对照的方法进行研究。手术前后大多数观察指标比较,差异有显著性(P＜0.01)。术后矫正HAV角平均21.03°±2.00°(其中轻度组矫正HAV 16.05°±0.49°;中度组矫正HAV20.79°±3.67°;重度组矫正HAV25.98°±0.31°);矫正IM角平均4.69°±0.19°(其中轻度组矫正IM 2.39°±0.24°;中度组矫正IM 4.31°±1.17°;重度组矫正IM 7.26°±1.25°);AOFAS评分术后平均提高31.52±11.01分(其中轻度组AOFAS提高30.62±10.73分;中度组AOFAS提高31.18±10.45分;重度组AOFAS提高32.75±12.34分);TSP术后平均纠正2.74±0.22(其中轻度组TSP矫正2.48±0.37;中度组TSP矫正2.70±0.14;重度组TSP矫正3.06±0.01)。证明了该规范化方案疗效显著,优良率99.1%。规范化方案针对各种程度的拇外翻足,采用个体化治疗,有效地纠正了HAV、IM等观察指标,大大地提高了优良率,优良率99.1%,与未规范化的方案(回顾性研究)比,优良率提高了7.1%。
3.3.2规范化的中西医结合微创技术治疗拇趾外翻诊疗方案在望京医院、电力医院及广安门医院三家分中心推广应用,经临床验证,疗效肯定、可靠,易于推广。优良率分别为96.7%(望京医院),93.3%(电力医院),93.3%(广安门医院)。
对90足拇外翻(望京医院30足;电力医院30足;广安门医院30足)采用规范化方案进行分型及治疗,并通过多中心、自身前后对照的方法进行研究。①该技术能很好地纠正HAV、IM、TSP、AOFAS等(P＜0.01),患者满意。验证了该规范化的诊疗方案在三家分中心推广应用疗效确定,优良率分别为96.7%(望京医院),93.3%(电力医院、广安门医院)。②三家分中心手术前后各项观察指标差值比较,均P＞0.05,说明了该规范化方案在三家分中心应用疗效肯定、可靠,易于推广。
3.3.3望京医院及冶金医院两家分中心分别采用规范化方案及传统大切口两种方法治疗拇趾外翻,经临床证实,疗效确定,优良率均为96.7%(望京医院、冶金医院);规范化方案优于传统大切口技术。
对60足拇外翻(望京医院30足;冶金医院30足)分别采用规范化方案及传统大切口进行诊疗并通过多中心、自身前后对照的方法进行研究。①验证了规范化方案治疗拇外翻可以获得同大切口技术相同的疗效(两家分中心各项观察指标手术前后比较,均P＜0.01;各项观察指标手术前后差值比较,均P＞0.05),望京医院与冶金医院优良率均为96.7%。②规范化方案优于大切口技术:术后拇内翻、拇外翻、术区足趾麻木、足部肿胀时间及术后第Ⅱ、Ⅲ跖骨头下胼胝体(胼胝痛)的发生,望京医院均较冶金医院少,原因在于1规范化系统损伤小2诊疗规范化。中药内服外用,活血化瘀、消肿止痛、补肾壮骨。传统大切口术式具有切口7～10cm,腰麻,缝合,需要内固定、止血带、二次手术,术后下地时间长,损伤大等特点,病人难以接受。而微创技术切口小于1cm,局麻,无需缝合、内固定、止血带及二次手术,损伤小,术后即可下地走路,深受广大患者欢迎。
3.4结论
通过对200足拇外翻采用多中心、自身前后对照的方法进行研究,经临床验证,证实了规范化的中西医结合微创技术治疗拇趾外翻诊疗方案疗效显著;在分中心推广应用疗效确定、可靠,易于推广;规范化的中西医结合诊疗方案治疗拇外翻可获得同传统大切口技术相同的疗效,且优于传统大切口技术。
4解剖学研究
4.1研究目的:
①了解中西医结合治疗拇外翻微创技术对足部解剖结构的影响②明确手术关键操作与周围血管、神经的位置关系③完善中西医结合治疗拇外翻的微创操作技术④研究并验证手术操作的安全性。
4.2材料与方法
解剖福尔马林溶液浸泡足6只(正常足4只;拇外翻足2只),研究并验证手术操作的安全性。
4.3结果
通过解剖福尔马林溶液浸泡足6只,结合文献及解剖图谱,验证了手术操作的安全性。
①外侧结构松解,不会损伤拇趾腓侧跖背动脉及跖底动脉,不会损伤拇内收肌在近节趾骨基底的止点,不会损伤腓深神经。
②第一跖骨头颈截骨,不会损伤拇长、短伸、屈肌腱及拇展肌肌腱,可能伤及足背内侧皮神经的分支及大隐静脉在拇趾背内侧的分支,因足部有丰富的静脉网代偿,故而截骨是安全的。
③通过截骨远端外移,初步恢复了跖籽系统与第一跖骨头的正常解剖关系。
4.4结论
通过解剖学研究证实了该规范化方案是安全的、可行的。
5本课题的创新点
①创立一套规范化的中西医结合微创技术治疗拇趾外翻的诊断、分型、治疗、康复及疗效评估体系。
②首次将多中心、自身前后对照的方法应用于中西医结合微创技术治疗拇趾外翻的研究中。
1A research background
Hallux valgus(HAV) is a common foot deformities.Mainly occurred in the 14 to 70-year-old female,male to female ratio was 1:20.The main clinical manifestations of the former deformity and pain,limited walking shoes,seriously affecting the quality of life of patients.Hallux valgus Chinese Name absence,but tendon injuries can be attributed to the "bone from the joint,the tendons trough" or arthralgia syndrome areas.Chinese medicine theory:Kidney Health main bone marrow,and feeble-Shing,liver and kidney inadequate,their debilitating,long-term fatigue,bone loss can be caused by the reinforcement beam and the hallux valgus deformity.Hallux valgus the early and mid-simply a Hallux valgus deformity,yet lead to other diseases, but the normal anatomy of tendons biased position,it is taking tendons,tendon distortion;if the latter part of the medial toe pain,or pain associated with plantar,and other abnormalities,limited walking foot and toe joint flexion and extension disadvantaged,shall be vested in the arthralgia syndrome.Hallux valgus pathological mechanism of the main events:Western medicine think of that①biomechanics②arthritis③neuromuscular of④traumatic.Tutor-Jianmin to the point made by Professor①Hallux valgus exist in the development of yin and yang balance,that is, inside and outside,back,the plantaris muscle tendon imbalance of yin and yang.②hallux valgus exist in the development "from the bone joints,tendons a trough" pathological mechanism.
There are many ways to traditional treatment to Hallux valgus more than 200, into six categories:①thumb cyst resection and soft tissue surgery;②the first metatarsophalangeal joint angioplasty;③osteotomy of the first metatarsal head and neck of the stem;④plantar Bone basement osteotomy;⑤special operation;⑥toe Prosthetic replacement.Traditional surgery,large incision,soft tissue injury,the need for fixed and fixed plaster,the patient suffering,recovered slowly after Shimoji late, high recurrence rate,there will be pain under the metatarsal head and other complications.20 since the end of the 1980s,mentor,Professor Wen Jianmin treated Hallux valgus at home and abroad and concluded on the basis of experience with complex fracture of the entire Chinese medicine approach,small splint pressure pad of paper Principle and the experience of Chinese medicine treatment of fractures, created the Integrated Treatment of Hallux valgus,renovation methods.Hallux valgus against the etiology and pathology at the same time dealing with,and achieved good results.Won many provinces,ministries,state-level awards.And promotion throughout the country,Hallux valgus patients cured of 2 million people.This treatment method is simple,orthopaedic satisfied with less recurrence of deformity, less postoperative pain,without internal fixation after Shimoji early,rapid recovery, fewer complications,is the best way for Hallux valgus.
However,in the promotion of the technology in the course of some of the awareness and operational errors,thus affecting surgical treatment.In order to improve Hallux valgus in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients,the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization postoperative rehabilitation and efficacy evaluation system.To describe the standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the system of clinics,we have adopted a multi-center, and self-control before and after,standardization programmes compared with the traditional large incision research methods to four Centre at 200 hallux valgus feet Clinical comparison.Including①A retrospective study;②Integrated Treatment of Hallux valgus standardization of treatment(standardized research programme、standardized multi-center study programme with the traditional standardized large incision control study)③Anatomical study.
2 A retrospective study
2.1 Purpose of the study:
Integrative Medicine will be confirmed excellently in the treatment of hallux valgus,and find inadequate.
2.2 Materials and Methods
1996 to 1999 of 150 feet 79 cases of hallux valgus,in accordance with their own before and after contrast control methods,observing and analyzing HAV,IM,and other indicators,the effect of the introduction of the new evaluation criteria,through SPSS13.0 statistical software for data analysis to study the effectiveness of the treatment method.
2.3 Results
2.3.1 Integrated Treatment of hallux valgus was verificated by clinics,effective, excellent rate 92%.
Integrated Treatment of hallux valgus correction can be good of HAV,IM,Ⅰ-Ⅱmetatarsal head distance and TSP,and other parameters(P＜0.01).Ⅱ、Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) after a 91.8% improvement.Excellent rate is 92%.Proof of integrative medicine verificated effectively treatment of hallux valgus deformity.
2.3.2 The urgency of the standardization of integrated Treatment of hallux valgus
2.3.2.1 Insufficients founded from retrospective study:
①Thumb varus after 2 feet(1.3 per cent).Analysis of this group in the thumb inversion reasons:1 overkill;2 a lack of regular inspection and promptly corrected.
②Postoperative residual mild to moderate hallux valgus 40 feet(26.7%), analyzing the reasons:a serious patients hallux valgus,past a cerebrovascular accident;lateral joint capsule contracture,the hallux valgus feet of three different levels were using the same surgical procedure to correct,the lack of individualized treatment,the results are not quite satisfied.
③Numbness of the District 4 feet(2.7 per cent).Toe with the medial branch of the superficial peroneal nerve in the subcutaneous course,can be hurt.
④AfterⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) no improvement(or heavier) 8 feet of the former Chief of the corpus callosum (the corpus callosum pain) of 8.2 per cent of the total group to 5.3%of cases,it is caused by that deformities is not completely correct.
2.3.2.2 Issues emerging from the process of Integrated Treatment of hallux valgus promoted at the grassroots level:
①First metatarsophalangeal joint medial Osteophyte to cut excessive grinding metatarsophalangeal joint anastomosis poor,unstable distal metatarsal block(to the side and lateral plantar angle) of thumb inversion.
②Osteotomy direction and angle of an overkill or being not completely correct.
③Lack of exercise,restricted or part of the great toe activities restricted.
④Necrosis induced by vascular injury in the toe and skin anesthesia of numb toes induced by nerve damage.
2.4 Conclusion
2.4.1 Integrated Treatment of hallux valgus is effective,high rate of 92%.
2.4.2 Integrated Treatment ofhallux valgus clinics system standardization is essential.
3 Integrated Treatment of hallux valgus standardized research
3.1 Purpose of the study:
①In view of the Integrated Treatment of hallux valgus the existing problems, the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization of evaluation and postoperative rehabilitation programme.Hallux valgus benefit of the increase in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients.
②On standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the treatment programme.
3.2 Materials and Methods
2006～2007 200 feet hallux valgus study,which①hallux valgus of 170 feet (110 feet WanNing Hospital;electricity hospital 30 foot;Guang'An Men hospital 30 feet) using standardized programme has been developed by the standardization of processes Classification and treatment,and a multi-center,and self-control method before and after contrast②30 feet hallux valgus(Metallurgy Hospital 30 feet) using traditional large incision,according to the surgical technique maturing(Austin, Mitchel) treatment,and adopt standardized Programme(WanNing Hospital 30 feet) contrast with the traditional large incision approach.Observation HAV,IM,such as 10 AOFAS indicators,and through SPSS13.0 statistical software for data analysis, research and verify the standardization of Integrated Treatment of Hallux valgus clinics programme effectiveness in the promotion of science and the application of feasibility.
3.3 Results
3.3.1 Standardized Integrated Treatment of Hallux valgus clinics programme has been verificated by clinical test results significantly.Excellent rate of 99.1%,and non-standardized Programme(retrospective study) ratio has been remarkably improved,the excellent and good rate increased 7.1%.
110 feet hallux valgus(WanNing Hospital) using standardized clinics and treatment programmes for a division,and through its own method of comparing before and after the study.Most observed before and after surgery,the difference was significant(P＜0.01).HAV correction after an average of 21.03°±2.00°(HAV correction of mild group 16.05°±0.49°;moderate group Correction HAV 20.79°±3.67°;severe correction group HAV 25.98°±0.31°);IM angle correction average 4.69°±0.19°(correction mild group IM 2.39°±0.24°;Correction moderate group IM 4.31°±1.17°;severe group Correction IM 7.26°±1.25°); TSP after correcting average 2.74±0.22(TSP mild group correction 2.48±0.37; moderate group TSP Correction 2.70±0.14;severe group TSP Correction 3.06±0.01);AOFAS score after an average of 31.52±11.01 points(including mild group AOFAS increased 30.62±10.73 points;moderate group AOFAS raise 31.18±10.45 points;severe group AOFAS increased 32.75±12.34 points).Proved that the significant effect of standardization programme,the excellent and good rate 99.1%.3.3.2 Standardized Integrated Treatment of Hallux valgus in the clinics programme Wangjing Hospital,Guang'An Men hospitals and electricity Hospital three Center application,verified by clinical efficacy sure no difference. Excellent rates were 96.7%(Wangjing Hospital),93.3%(electricity Hospital), 93.3%(Guang'An Men Hospital).
Hallux valgus 90 feet(30 feet Wangjing Hospital;electricity hospital 30 foot; Guang'An Men hospital 30 feet) using standardized programme type and treatment, and through multi-center,and self-control method before and after the study.①well the technology can correct HAV,IM,TSP,AOFAS(P＜0.01),and patient satisfaction. Validity of the standardized treatment programmes in the three centers promote the use of identification,excellent rates were 96.7%(Wangjing Hospital),93.3% (electricity hospitals,Guang'An Men Hospital).②three centers before and after surgery compared the observed difference,P＞0.05,shows that the standardization programmes in the three sub-centre applications no difference in efficacy.
3.3.3 Wangjing Hospital and metallurgical hospital two centers were used standardized programmes and the traditional large incision two methods for Hallux valgus,the clinically proven efficacy determined that no difference, excellent rates of 96.7%(Wangjing Hospital,metallurgical hospitals); standardization programme is better than the traditional large incision technology.
Hallux valgus 60 feet(30 feet Wangjing Hospital;metallurgical hospital 30 feet) were used standardized programmes and the traditional large incision and clinics through a multi-center,and self-control method before and after the study.①a standardized test in the treatment of hallux valgus with the large incision can be the same technical effect(two centers of the observed before and after surgery,all P＜0.01;the observed difference compared before and after surgery,all P＞0.05), Wangjing Hospital and metallurgical hospitals are excellent rate 96.7%.②standardization programme is better than large incision technology:In thumb after varus,hallux valgus,the toe area of numbness,swelling of the foot time and postoperativeⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) occurred,Wangjing Hospital is less than Metallurgical hospitals,because of a standardized system injury two small clinics standardization.Chinese Herbs topical, Blood Circulation,swelling pain,Bushen Zhuanggu.Traditional large incision technique is 7-10 cm incision,spinal anesthesia,suture,the need for a fixed, tourniquet,the second surgery,go after a long time,the characteristics of the injury, poor compliance of patients.The minimally invasive technique is less than 1 cm incision,local anesthesia,no suture,internal fixation,tourniquet and secondary surgery,injury,after Shimoji can walk,welcomed by the overwhelming majority of patients,and good compliance.
3.4 Conclusion
Through 200 feet hallux valgus a multi-center,and self-control and the method of contrast studies of standardization programmes and the traditional large incision technology,by the clinical test,confirming that the standardization of integrated treatment of Hallux valgus programme of clinics significantly;Application at the centre of identification,and no difference in efficacy;standardized in Integrative Medicine clinic programme will be with traditional large incision of the same technology,and technology is superior to the traditional large incision.
4 Anatomical study
4.1 The purpose of the study:
①Understanding of combining traditional Chinese and western medicine treatment of hallux valgus minimally invasive technique of anatomical structure of the foot②Clear surgical operation and key peripheral vascular,neurological③Improve relations between the location of Integrated Treatment of the hallux valgus minimally invasive technique to study and verify④The safety of surgical operations.
4.2 Materials and Methods
Anatomy of formalin solution immersion foot six,research and verify the safety of surgical incision and release.
4.3 Results
Through anatomy of formalin solution immersion foot six,combining literature and anatomical map,the safety of surgical incision and release has been verified.
①Lateral structure release,not great toe injury fibular dorsal metatarsal artery and plantar artery,not the thumb injury to muscle in the basement near the toe section only,not deep peroneal nerve injury.
②Osteotomy of the first metatarsal head and neck,thumb injury will not be long,short stretch,the flexor tendon and muscle tendon thumb exhibition,may hurt the medial dorsal foot nerve and a branch of the saphenous vein in the great toe back inside the branch,Because of the foot is rich in compensatory vein network,therefore osteotomy is safe.
③Through the relocation of the distal osteotomy,the initial resumption of the first metatarsal seed system and the first metatarsal head of the anatomy of normal relations is true.
4.4 Conclusion
Anatomy analysis confirmed that the standardization programme is safe and feasible.
5 Topics innovation
①Creation of a standardized Integrated Treatment of Hallux valgus in the diagnosis,treatment,rehabilitation and efficacy evaluation system.
The first multi-center,and self-control before and after the method has been applied to Integrated Treatment of Hallux valgus in the study.
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