[1]陈浩宇 黄昭华 高峻青△ 李宏亮 王兮 付记乐 李卓伟.不同截骨术式联合无头加压螺钉治疗外翻畸形的临床疗效对比[J].中国中医骨伤科杂志,2020,28(07):16-20.
　CHEN Haoyu HUANG Zhaohua GAO Junqing LI Hongliang WANG Xi FU Jile LI Zhuowei.Clinical Efficacy Comparison of Different Osteotomy Method Combined with Acutrak Screw in Treatment of Hallux Valgus[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(07):16-20.
点击复制

不同截骨术式联合无头加压螺钉治疗外翻畸形的临床疗效对比()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年07期
页码:
16-20
栏目:
临床研究
出版日期:
2020-07-10

文章信息/Info

Title:
Clinical Efficacy Comparison of Different Osteotomy Method Combined with Acutrak Screw in Treatment of Hallux Valgus
文章编号:
1005-0205(2020)07-0021-03
作者:
陈浩宇1 黄昭华1 高峻青1△ 李宏亮1 王兮1 付记乐1 李卓伟1
1广东佛山市中医院(广东 佛山,528000)
Author(s):
CHEN Haoyu1 HUANG Zhaohua1 GAO Junqing1△ LI Hongliang1 WANG Xi1 FU Jile1 LI Zhuowei1
1Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong China.
关键词:
截骨矫形;  外翻;  无头加压螺钉;  疗效对比
Keywords:
osteotomy;  hallux valgus;  acutrak screw;  efficacy comparison
分类号:
R681.8
文献标志码:
A
摘要:
目的:探究Scraf截骨与Chevron截骨联合无头加压螺钉(Acutrak螺钉)治疗外翻畸形的临床疗效。 方法:回顾2015年1月至2018年6月外翻畸形患者共41例68足,男4例,女37例; 年龄22～66岁,平均(43.37±9.59)岁。术中采用Chevron或Scraf截骨术式,并仅用Acutrak螺钉加压固定截骨端。根据截骨术式分为Chevron截骨组和Scraf截骨组,随访两组患者手术前后患足负重位X线片、AOFAS评分、术后并发症及患者满意度等指标来评定临床疗效。结果:随访时间13～24个月,平均(18.25±6.73)个月。影像学结果显示所有病例术后外翻角(HVA)及跖骨间角(IMA)较术前明显改善,差异有统计学意义(P<0.01),其中Chevron截骨组术后平均改善11°和4°,Scraf截骨组术后平均改善24°和9°,差异有统计学意义(P<0.01)。手术前后Chevron截骨组和Scraf截骨组AOFAS评分分别由(51.13±7.35)和(49.24±6.42)分提高至(88.77±5.53)和(89.27±5.66)分,两组患者术后评分较术前明显改善,差异有统计学意义(P<0.01)。随访两组患者未见术后并发症发生。术后两组患者对患足外观、穿鞋舒适度方面满意度评分,所有患者总满意度为90%,其中Scraf截骨组患者满意度(95%)高于Chevron截骨组满意度(84%),差异有统计学意义(P<0.05)。结论:Scraf截骨与Chevron截骨均能治疗外翻畸形,但Scraf截骨联合Acutrak螺钉能获得更强的矫正能力及更高的患者满意度。
Abstract:
Objective:To explore the clinical efficacy of Scraf osteotomy and Chevron osteotomy method combined with the Acutrak screw internal fixation in treating hallux valgus. Methods:41 patients(68 feet)with hallux valgus deformity were included from January 2015 to June 2018. There were 4 male and 37 females with aged from 22 to 66 years and(43.37±9.59)years on average. Chevron and Scraf osteotomy were respectively used with Acutrak screws as the internal fixation in two groups. The full weight X-rays of patients were performed preoperatively and postoperatively. American Orthopaedic Foot and Ankle Society score(AOFAS scores),complications and patients' satisfaction of preoperatively and more than 1 year postoperatively were documented. Results:Follow-up time were 13 to 24 months with(18.25±6.73)months on average. The radiologic results showed significant improvement in the HVA and IMA of all patients(Chevron:mean 11° improvement in HVA(P<0.01),mean 4° improvement IMA(P<0.01).Scraf:mean 24° improvement in HVA(P<0.01),mean 9° improvement IMA(P<0.01)). The preoperatively and postoperatively AOFAS scores of Chevron osteotomy group and Scraf osteotomy group were significantly increased from(51.13±7.35)and(49.24±6.42)points to(88.77±5.53)and(89.27±5.66)points respectively(P<0.01). No postoperative complications were observed in all patients. The whole satisfaction rate of the appearance of the foot and the comfort of wearing shoes after the operation were about 90%. Rate in the Scraf osteotomy group(95%)was higher than the Chevron osteotomy group(84%),and the statistically significant difference was found between those two groups. Conclusion:Both Scraf and Chevron osteotomy with Acutrak screw can well treat hallux valgus,but Scraf osteotomy method can obtain stronger correction ability and higher patient satisfaction.

参考文献/References:

[1] EASLEY M E,TRNKA H J. Current concepts review:hallux valgus part Ⅱ:operative treatment[J]. Foot Ankle Int,2007,28(6):748-758.
[2] WAGNER E,ORTIZ C,TORRES K,et al. Cost effectiveness of different techniques in hallux valgus surgery[J]. Foot Ankle Surg,2016,22(4):259-264.
[3] MA Q,LIANG X,LU J. Chevron osteotomy versus scarf osteotomy for hallux valgus correction:a meta-analysis[J]. Foot Ankle Surg,2019,25(6):755-760.
[4] LEHMAN D E. Salvage of complications of hallux valgus surgery[J].Foot and Ankle Clinics,2003,8(1):15-35.
[5] ODUWOLE K O,CICHY B,DILLON J P,et al.Acutrak versus Herber screw fixation for scaphoid non-union and delayed union[J].J Orthop Surge(Hong Kong),2012,20(1):61-65.
[6] FADEL G E,HUSSAIN S M,SRIPADA S,et al. Fixation of first metatarsal basal osteotomy using Acutrak screw[J].Foot Ankle Surg,2008,14(1):21-25.
[7] MALATRAY M,FESSY M H,BESSE J L. Comparison of screw versus locked plate fixation for Scarf osteotomy treatment of hallux valgus[J]. Orthop Traumatol Surg Res,2018,104(5):725-731.
[8] MANN R A,COUGHLIN M J. Hallux Valgus-Etiology,anatomy,treatment and surgical considerations[J].Clinical Orthopaedics and Related Research,1981,157:31-41.
[9] SAYLI U,AKMAN B,TANRIOVER A,et al. The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus[J]. Foot Ankle Surg,2018,24(5):448-452.
[10] BAI L B,LEE K B,SEO C Y,et al. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity[J]. Foot Ankle Int,2010,31(8):683-688.
[11] SWANTON E,MASON L,MOLLOY A. How do I use the Scarf osteotomy to rotate the metatarsal and correct the deformity in three dimensions[J]. Foot Ankle Clin,2018,23(2):239-246.
[12] ELSHAZLY O,ABDEL RAHMAN A F,FAHMY H,et al. Scarf versus long chevron osteotomies for the treatment of hallux valgus:a prospective randomized controlled study[J]. Foot Ankle Surg,2019,25(4):469-477.
[13] DE VIL J J K,VAN SEYMORTIER P,BONGAERTS W,et al.Scarf osteotomy for hallux valgus deformity:a prospective study with 8 years of clinical and radiologic follow-up[J].Journal of the American Podiatric Medical Association,2010,100(1):35-40.
[14] CURTIN M,MURPHY E,BRYAN C,et al. Scarf osteotomy without internal fixation for correction of hallux valgus:a clinical and radiographic review of 148 cases[J]. Foot Ankle Surg,2018,24(3):252-258.
[15] WAGNER P,WAGNER E. Is the rotational deformity important in our decision-making process for correction of hallux valgus deformity? [J]. Foot Ankle Clin,2018,23(2):205-217.
[16] CHOI Y R,LEE H S,JEONG J J,et al. Hallux valgus correction using transarticular lateral release with distal chevron osteotomy[J]. Foot Ankle Int,2012,33(10):838-843.
[17] PLAASS C,VON FALCK C,ETTINGER S,et al. Bioabsorbable magnesium versus standard titanium compression screws for fixation of distal metatarsal osteotomies-3 year results of a randomized clinical trial[J]. J Orthop Sci,2018,23(2):321-327.
[18] KOMUR B,YILMAZ B,KAAN E,et al. Mid-term results of two different fixation methods for Chevron osteotomy for correction of hallux valgus[J]. J Foot Ankle Surg,2018,57(5):904-909.
[19] ABBEN K W,SORENSEN M D,WAVERLY B J. Immediate weightbearing after first metatarsophalangeal joint arthrodesis with screw and locking plate fixation:a short-term review[J]. J Foot Ankle Surg,2018,57(4):771-775.
[20] TONOGAI I,WADA K,HIGASHINO K,et al. Location and direction of the nutrient artery to the first metatarsal at risk in osteotomy for hallux valgus[J]. Foot Ankle Surg,2018,24(5):460-465.

备注/Memo

备注/Memo:
(收稿日期:2019-12-03)基金项目:佛山市十三五医学重点专科建设项目 (FSZDZK135019) △通信作者 E-mail:gao-7950@163.com
更新日期/Last Update: 2020-07-10