中国修复重建外科杂志

中国修复重建外科杂志

Scarf 截骨联合 Akin 截骨可吸收螺钉或金属螺钉固定治疗中重度鰒外翻畸形疗效比较

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目的 通过临床及影像学评估 Scarf 截骨联合 Akin 截骨治疗中重度ル外翻可吸收螺钉或金属螺钉固定截骨的疗效差异。 方法 2014 年 3 月—2016 年 5 月,采用 Scarf 截骨联合 Akin 截骨治疗中重度ル外翻患者 62 例(83 足),其中 25 例(35 足)采用可吸收螺钉固定(A 组),37 例(48 足)采用金属螺钉固定(B 组)。两组患者性别、年龄、发病侧别、发病原因、ル外翻严重程度、病程、术前负重正位 X 线片测量的ル外翻角(hallux valgus angle,HVA)和第 1、2 跖骨间角(first-second intermetatarsal angle,1-2IMA)、术前美国矫形足踝协会(AOFAS)评分、疼痛视觉模拟评分(VAS)等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者并发症发生情况和截骨愈合时间;末次随访时采用 AOFAS 评分、VAS 评分以及足负重正位 X 线片测量的 HVA 和 1-2IMA 评价疗效。 结果 术后两组患者切口均Ⅰ期愈合,无切口相关并发症发生。两组患者均获随访,A 组随访时间 12~36 个月,平均 24.4 个月;B 组为 14~38 个月,平均 25.7 个月。A 组术后 1 足并发ル内翻,2 足出现轻度ル僵硬,1 足出现转移性跖痛;B 组分别为 2、3、2 足;两组术后均无ル外翻复发;两组患足首次术后并发症发生率比较差异无统计学意义(χ2=0.275,P=0.843)。B 组 89.2%(33 例)患足二次手术取出内固定物,其中 3 例取出时出现螺钉滑丝,1 例发生螺钉断裂;10.8%(4 例)因年龄较大拒绝二次手术取出内固定物。术后 X 线片示两组截骨处均愈合良好,两组愈合时间比较差异无统计学意义(t=1.633,P=0.285)。末次随访时两组患者 AOFAS 评分、VAS 评分及 HVA 和 1-2IMA 均较术前显著改善(P<0.05);两组间上述指标比较差异均无统计学意义(P>0.05)。 结论 Scarf 联合 Akin 截骨治疗中重度ル外翻效果显著,并发症较少;可吸收螺钉固定截骨疗效与金属螺钉固定相当,但避免了二次手术取出内固定物的相关风险。

Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.

关键词: ル外翻; Scarf 截骨术; Akin 截骨术; 可吸收螺钉; 金属螺钉; 内固定

Key words: Hallux valgus; Scarf osteotomy; Akin osteotomy; absorbable screw; metal screw; internal fixation

引用本文: 蔡杰, 屈福锋, 刘培珑, 赵宏谋, 王军虎, 李毅, 曾秋, 姬维娜, 梁晓军. Scarf 截骨联合 Akin 截骨可吸收螺钉或金属螺钉固定治疗中重度鰒外翻畸形疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1386-1391. doi: 10.7507/1002-1892.201805116 复制

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