第一跖趾关节融合治疗足拇外翻临床疗效观察
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摘要
目的探讨第一跖趾关节融合术治疗足拇外翻的临床疗效。方法回顾性分析2015年2月至2018年6月首都医科大学附属北京友谊医院收治的因拇外翻行第一跖趾关节融合手术的31例患者的病例资料。手术均采取切开融合,固定方法采用锁定接骨板固定,术前、术后分别测量拇外翻角(HVA)、第一二跖骨间角(IMA)及美国矫形足踝学会足功能评分系统(AOFAS)评分并进行比较,并观察术后第一跖趾关节融合情况,术后伤口愈合情况、感染等并发症发生情况。结果术后AOFAS评分(88. 29±3. 37)分较术前(75. 90±6. 78)分明显提高,临床疗效满意;术后HVA(11.45°±16. 18°)较术前(28. 90°±4. 86°)明显改善,拇外翻畸形矫正满意;术后IMA角度(8. 48°±1. 57°)较术前(16. 29°±3. 00°)也有明显改善,改善了前足宽度。没有不融合病例,2例患者伤口不愈合,经治疗后痊愈。无感染病例。结论第一跖趾关节融合治疗拇外翻,患足术后外观、功能均明显改善,术后拇外翻畸形不复发,并发症少,治疗效果满意。
Objective To investigate the clinical observation of first metatarsophalangeal joint arthrodesis in the treatment of hallux valgus. Methods Retrospective analysis was performed in 31 cases of hallux valgus treated with first metatarsophalangeal joint fusion from February 2015 to June 2018. The hallux valgus angle( HVA),the first and second metatarsal angle( IMA) and the American Orthopaedic Foot & Ankle Society( AOFAS) the foot function score system were measured and compared before and after the operation. The first metatarsophalangeal joint fusion,wound healing,infection and other complications were observed. Results Postoperative AOFAS score( 88. 29 ± 3. 37) was significantly higher than preoperative score( 75. 90 ± 6. 78),and the clinical effect was satisfactory. Postoperative HVA( 11. 45° ± 16. 18°) was significantly improved compared with preoperative score( 28. 90° ± 4. 86°),and hallux valgus deformity was corrected satisfactorily. Postoperative IMA angle( 8. 48° ± 1. 57°) was also significantly improved compared with preoperative score( 16. 29° ± 3. 00°),which improved the width of forefoot.There were all cases of fusion. The wounds of 2 patients did not heal and recovered after treatment. There were no cases of infection. Conclusion The first metatarsophalangeal joint fusion for hallux valgus can obviously improve the appearance and function of the affected foot after operation.There is no recurrence and fewer complications after operation. The effect of operation is satisfactory.
Objective To investigate the clinical observation of first metatarsophalangeal joint arthrodesis in the treatment of hallux valgus. Methods Retrospective analysis was performed in 31 cases of hallux valgus treated with first metatarsophalangeal joint fusion from February 2015 to June 2018. The hallux valgus angle( HVA),the first and second metatarsal angle( IMA) and the American Orthopaedic Foot & Ankle Society( AOFAS) the foot function score system were measured and compared before and after the operation. The first metatarsophalangeal joint fusion,wound healing,infection and other complications were observed. Results Postoperative AOFAS score( 88. 29 ± 3. 37) was significantly higher than preoperative score( 75. 90 ± 6. 78),and the clinical effect was satisfactory. Postoperative HVA( 11. 45° ± 16. 18°) was significantly improved compared with preoperative score( 28. 90° ± 4. 86°),and hallux valgus deformity was corrected satisfactorily. Postoperative IMA angle( 8. 48° ± 1. 57°) was also significantly improved compared with preoperative score( 16. 29° ± 3. 00°),which improved the width of forefoot.There were all cases of fusion. The wounds of 2 patients did not heal and recovered after treatment. There were no cases of infection. Conclusion The first metatarsophalangeal joint fusion for hallux valgus can obviously improve the appearance and function of the affected foot after operation.There is no recurrence and fewer complications after operation. The effect of operation is satisfactory.
引文
[1]Wood EV,Walker CR,Hennessy MS. First metatarsophalangeal arthrodesis for hallux valgus[J]. Foot Ankle Clin,2014,19(2):245-258.
[2]Little JB. First metatarsophalangeal joint arthrodesis in the treatment of hallux valgus[J]. Clin Podiatr Med Surg,2014,31(2):281-289.
[3]Smyth NA,Aiyer AA. Introduction:Why Are There so Many Different Surgeries for Hallux Valgus[J]? Foot Ankle Clin,2018,23(2):171-182.
[4]Rammelt S,Panzner I,Mittlmeier T. Metatarsophalangeal Joint Fusion:Why and How[J]? Foot Ankle Clin,2015,20(3):465-477.
[5]Dalat F,Cottalorda F,Fessy MH,et al. Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates[J]. Orthop Traumatol Surg Res,2015,101(6):709-714.
[6]Bauer T,Lortat-Jacob A,Hardy P. First metatarsophalangeal joint percutaneous arthrodesis[J]. Orthop Traumatol Surg Res,2010,96(5):567-573.
[7]Lui TH. Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Valgus Deformity[J]. Arthrosc Tech,2017,6(5):e1481-e1487.
[8]Stevens BW,Anderson JG,Bohay DR. Hallux metatarsophalangeal joint fusion for the rheumatoid forefoot[J]. Foot Ankle Clin,2007,12(3):395-404.
[9]Mandell D,Karbassi J,Zhou H,et al. A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion:A biomechanical comparison[J]. Foot(Edinb),2018,34:69-73.
[10]Singhal R,Kwaees T,Mohamed M,et al. Result of IOFIX(Intra Osseous FIXation)device for first metatarsophalangeal joint arthrodesis:A single surgeon's series[J]. Foot Ankle Surg,2018,24(5):466-470.
[11]Harris E,Moroney P,TournéY. Arthrodesis of the first metatarsophalangeal joint-A biomechanical comparison of four fixation techniques[J]. Foot Ankle Surge,2017,23(4):268-274.
[12]Storts EC,Camasta CA. Immediate Weightbearing of First Metatarsophalangeal Joint Fusion Comparing Buried Crossed Kirschner Wires Versus Crossing Screws:Does Incorporating the Sesamoids Into the Fusion Contribute to Higher Incidence of Bony Union?[J]. J Foot Ankle Surg,2016,55(3):562-566.
[13]Bass EJ,Sirikonda SP. 1st metatarsophalangeal joint fusion:A comparison of non-union and gender differences between locking and nonlocking plating systems[J]. Foot(Edinb),2015,25(4):195-199.
[14]Asif M,Qasim SN,Kannan S,et al. A Consecutive Case Series of 166First Metatarsophalangeal Joint Fusions Using a Combination of Cup and Cone Reamers and Crossed Cannulated Screws[J]. J Foot Ankle Surg,2018,57(3):462-465.
[15]Donegan RJ,Blume PA. Functional Results and Patient Satisfaction of First Metatarsophalangeal Joint Arthrodesis Using Dual Crossed Screw Fixation[J]. J Foot Ankle Surg,2017,56(2):291-297.
[16]Wanivenhaus F,Espinosa N,Tscholl PM,et al. Quality of Early Union After First Metatarsophalangeal Joint Arthrodesis[J]. J Foot Ankle Surg,2017,56(1):50-53.
[2]Little JB. First metatarsophalangeal joint arthrodesis in the treatment of hallux valgus[J]. Clin Podiatr Med Surg,2014,31(2):281-289.
[3]Smyth NA,Aiyer AA. Introduction:Why Are There so Many Different Surgeries for Hallux Valgus[J]? Foot Ankle Clin,2018,23(2):171-182.
[4]Rammelt S,Panzner I,Mittlmeier T. Metatarsophalangeal Joint Fusion:Why and How[J]? Foot Ankle Clin,2015,20(3):465-477.
[5]Dalat F,Cottalorda F,Fessy MH,et al. Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates[J]. Orthop Traumatol Surg Res,2015,101(6):709-714.
[6]Bauer T,Lortat-Jacob A,Hardy P. First metatarsophalangeal joint percutaneous arthrodesis[J]. Orthop Traumatol Surg Res,2010,96(5):567-573.
[7]Lui TH. Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Valgus Deformity[J]. Arthrosc Tech,2017,6(5):e1481-e1487.
[8]Stevens BW,Anderson JG,Bohay DR. Hallux metatarsophalangeal joint fusion for the rheumatoid forefoot[J]. Foot Ankle Clin,2007,12(3):395-404.
[9]Mandell D,Karbassi J,Zhou H,et al. A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion:A biomechanical comparison[J]. Foot(Edinb),2018,34:69-73.
[10]Singhal R,Kwaees T,Mohamed M,et al. Result of IOFIX(Intra Osseous FIXation)device for first metatarsophalangeal joint arthrodesis:A single surgeon's series[J]. Foot Ankle Surg,2018,24(5):466-470.
[11]Harris E,Moroney P,TournéY. Arthrodesis of the first metatarsophalangeal joint-A biomechanical comparison of four fixation techniques[J]. Foot Ankle Surge,2017,23(4):268-274.
[12]Storts EC,Camasta CA. Immediate Weightbearing of First Metatarsophalangeal Joint Fusion Comparing Buried Crossed Kirschner Wires Versus Crossing Screws:Does Incorporating the Sesamoids Into the Fusion Contribute to Higher Incidence of Bony Union?[J]. J Foot Ankle Surg,2016,55(3):562-566.
[13]Bass EJ,Sirikonda SP. 1st metatarsophalangeal joint fusion:A comparison of non-union and gender differences between locking and nonlocking plating systems[J]. Foot(Edinb),2015,25(4):195-199.
[14]Asif M,Qasim SN,Kannan S,et al. A Consecutive Case Series of 166First Metatarsophalangeal Joint Fusions Using a Combination of Cup and Cone Reamers and Crossed Cannulated Screws[J]. J Foot Ankle Surg,2018,57(3):462-465.
[15]Donegan RJ,Blume PA. Functional Results and Patient Satisfaction of First Metatarsophalangeal Joint Arthrodesis Using Dual Crossed Screw Fixation[J]. J Foot Ankle Surg,2017,56(2):291-297.
[16]Wanivenhaus F,Espinosa N,Tscholl PM,et al. Quality of Early Union After First Metatarsophalangeal Joint Arthrodesis[J]. J Foot Ankle Surg,2017,56(1):50-53.