| 经跖骨间切口与内侧切口外侧软组织松解联合Scarf截骨治疗中重度拇外翻的临床疗效比较 |
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Received:May 09, 2025
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| 作者 | Author | 单位 | Unit | E-Mail |
| 温丰平 |
WEN Feng-ping |
恩施土家族苗族自治州中心医院关节外科, 湖北 恩施 445000 |
Department of Joint Surgery, the Central Hospital of Enshi Prefecture, Enshi 445000, Hubei, China |
ww122900@whu.edu.cn |
| 刘行 |
LIU Xing |
恩施土家族苗族自治州中心医院关节外科, 湖北 恩施 445000 |
Department of Joint Surgery, the Central Hospital of Enshi Prefecture, Enshi 445000, Hubei, China |
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| 陈崇阳 |
CHEN Chong-yang |
恩施土家族苗族自治州中心医院关节外科, 湖北 恩施 445000 |
Department of Joint Surgery, the Central Hospital of Enshi Prefecture, Enshi 445000, Hubei, China |
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| 田世坤 |
TIAN Shi-kun |
恩施土家族苗族自治州中心医院关节外科, 湖北 恩施 445000 |
Department of Joint Surgery, the Central Hospital of Enshi Prefecture, Enshi 445000, Hubei, China |
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| 期刊信息：《中国骨伤》2025年38卷，第6期，第559-565页 |
| DOI：10.12200/j.issn.1003-0034.20241127 |
| 基金项目:2023年恩施州"硒引工程"科技项目(编号:D20230028) |
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目的：比较经跖骨间切口与内侧切口外侧软组织松解联合Scarf截骨治疗中重度拇外翻(hallux valgus,HV)的临床疗效。
方法：回顾性分析2022年1月至2022年12月收治的42例中重度HV患者的临床资料,根据切口不同分为内侧切口组22例(22足)和经跖骨间切口组20例(20足)。内侧切口组男3例,女19例;年龄40~69(55.0±11.4)岁;身体质量指数(body mass index,BMI)为21~29(25.2±2.1) kg·m-2;病程8~16(12.0±2.2)年;中度畸形11例,重度畸形11例。经跖间切口组男3例,女17例;年龄39~68(53.0±7.5)岁;BMI为20~28(24.8±1.9) kg·m-2;病程9~17(14.0±3.1)年;中度畸形9例,重度畸形11例。观察并比较两组术前及术后12个月拇外翻角(hallux valgus angle,HVA)、第1-2跖间角(intermetatarsal angle,IMA)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)前足评分和并发症发生情况。
结果：所有患者顺利完成手术,并获得随访,时间12~15(13.52±1.65)个月。两组术前及术后12个月HVA、IMA比较,差异均无统计学意义(P>0.05)。内侧切口组术前及术后12个月AOFAS前足评分分别为(45.0±6.8)、(86.0±6.7)分,经跖骨间切口组分别为(46.0±7.4)、(83.0±7.5)分;两组术后12个月AOFAS前足评分与术前比较,差异有统计学意义(P<0.01);其中内侧切口组AOFAS前足评分优8例,良14例;经跖间切口组优6例,良14例。术后12个月,内侧切口组AOFAS前足评分中功能评分(38.0±2.5)分优于经跖间切口组(34.0±2.2)分,差异有统计学意义(P<0.05)。内侧切口组术后HV畸形复发1足,经跖间切口组3趾出现轻微麻木感,3例对瘢痕不满意。两组均未出现感染、骨不连或跖骨头缺血性坏死并发症。
结论：经跖骨间切口与内侧切口外侧软组织松解联合Scarf截骨均可有效治疗中重度HV,内侧切口术后功能恢复优于经跖骨间切口。 |
| [关键词]:拇外翻 Scarf 截骨 外侧软组织松解 病例对照研究 |
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| Comparison of clinical efficacy of transmetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy in the treatment of moderate to severe hallux valgus |
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Abstract:
Objective To compare clinical efficacy of intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy in treating moderate to severe hallux valgus (HV).
Methods A retrospective analysis was conducted on clinical data of 42 patients with moderate to severe HV admitted from January 2022 to December 2022. According to different incisions,the patients were divided into medial incision group with 22 patients (22 feet) and intermetatarsal incision group with 20 patients (20 feet). In medial incision group,there were 3 males and 19 females,aged from 40 to 69 years old with an average of (55.0±11.4) years old;body mass index (BMI) ranged from 21 to 29 kg·m-2 with an average of (25.2±2.1) kg·m-2;the courses of disease ranged from 8 to 16 years with average of (12.0±2.2) years;11 patients with moderate deformity and 11 patients with severe deformity. In transplantar incision group,there were 3 males and 17 females,aged from 39 to 68 years old with an average of (53.0±7.5) years old;BMI ranged from 20 to 28 kg·m-2 with an average of (24.8±1.9) kg·m-2; the courses of disease ranged from 9 to 17 years with an average of (14.0±3.1) years;9 patients with moderate deformity and 11 patients with severe deformity. Hallux valgus angle (HVA) and the first-second intermetatarsal angle (IMA),American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and complications between two groups before operation and 12 months after operation were observed and compared.
Results All patients were successfully completed the surgery and were followed up for 12 to 15 months with an average of (13.52±1.65) months. There were no statistically significant difference in HVA and IMA between two groups before operation and 12 months after operation (P>0.05). AOFAS forefoot scores of medial incision group before operation and 12 months after operation were (45.0±6.8) and (86.0±6.7) respectively,and those of transmetatarsal incision group were (46.0±7.4) and (83.0±7.5) respectively. Postoperative AOFAS forefoot scores between two groups at 12 months were statistically significant compared with those of before operation (P<0.01). According to AOFAS forefoot scores,8 patients got excellent result,14 good in medial incision group;while 6 excellent and 14 good in transplantar incision group. At 12 months,postoperative AOFAS forefoot score of functional score of in medial incision group (38.0±2.5),was better than that in transplantar incision group (34.0±2.2),and the difference was statistically significant (P<0.05). One patient in medial incision group occurred HV deformity,mild numbness occurred in 3 toes in transplantar incision group,and 3 patients were dissatisfied with scar. No complications such as infection,nonunion of bones or ischemic necrosis of metatarsal heads occurred in either group.
Conclusion Both intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy can effectively treat moderate to severe HV. The functional recovery after medial incision is better than that after intermetatarsal incision. |
| KEYWORDS:Hallux valgus Scarf osteotomy Lateral soft tissue release Case control study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 温丰平,刘行,陈崇阳,田世坤.经跖骨间切口与内侧切口外侧软组织松解联合Scarf截骨治疗中重度拇外翻的临床疗效比较[J].中国骨伤,2025,38(6):559~565 |
| 英文格式: | WEN Feng-ping,LIU Xing,CHEN Chong-yang,TIAN Shi-kun.Comparison of clinical efficacy of transmetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy in the treatment of moderate to severe hallux valgus[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(6):559~565 |
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