Scarf截骨治疗跖内收型青少年外翻的早期疗效
Evaluation of the therapeutic efficacy of Scarf osteotomy in treating metatarsal varus type adolescent hallux valgus
祁印泽 1唐广君 2李昕宇 1魏芳远1
作者信息
- 1. 北京中医药大学第三附属医院手足外科,北京 100029
- 2. 北京中医药大学,北京 100029
- 折叠
摘要
目的 探讨Scarf截骨术治疗跖内收型青少年外翻的早期疗效.方法 回顾性分析2022年7月至2023年8月北京中医药大学第三附属医院手足外科采用Scarf截骨术治疗的跖骨内收型青少年外翻患者20例,男4例、女16例,年龄(16.2±2.4)岁(范围14～19岁),双足10例、单足10例.术中截骨前先松解外侧关节囊、籽骨悬韧带、收肌,于第一跖骨干部做"Z"形截骨,将截骨远端做一定程度短缩、截除楔形骨块,利用平移和旋转将第一跖骨向第二跖骨方向推挤直至挤压第二跖骨头,减小跖内收角度.比较术前、术后即刻、末次随访时的外翻角、第一、二跖骨间角、跖内收角、第二至五跖骨间角及疼痛视觉模拟评分(visual analogue scale,VAS).结果 20例患者均顺利完成手术,切口均愈合良好,无一例发生感染.截骨端临床愈合时间为(5.1±0.7)周(范围4.1～6.6周).所有患者均获得随访,随访时间(12.0±5.4)个月(范围2～18个月).术前、术后即刻、末次随访时外翻角分别为35.40°±5.45°、6.93°±3.60°、9.83°±2.65°,差异有统计学意义(F=289.214,P＜0.001);第一、二跖骨间角分别为 11.50°(9.75°,14.00°)、1.50°(0.00°,2.00°)、1.50°(0.00°,2.00°),差异有统计学意义(H=53.255,P＜0.001);跖内收角分别为 22.80°±2.60°、20.63°±2.27°、20.67°±2.20°,差异有统计学意义(F=47.041,P＜0.001);第二至五跖骨间角分别为 19.03°±1.85°、15.37°±1.33°、16.03°±1.73°,差异有统计学意义(F=74.450,P＜0.001).术后所有指标均较术前改善,其中外翻角末次随访时与术后即刻的差异有统计学意义(P＜0.05).术前、术后6～8周的VAS评分分别为(2.60±1.64)分、(1.30±0.92)分,差异有统计学意义(t=4.330,P＜0.001).随访期间无一例发生转移性跖骨痛和复发内翻.结论 采用Scarf截骨术治疗跖内收型外翻可有效矫正第一跖骨内收,同时对其余跖骨的内收状态有不同程度的改善效果,术后早期疗效满意.
Abstract
Objective To investigate the efficacy of the Scarf osteotomy in treating adolescents with metatarsus adductus-type hallux valgus.Methods A retrospective analysis was conducted on 20 patients(30 feet)treated with the Scarf osteotomy for metatarsus adductus-type hallux valgus at the Department of Hand and Foot Surgery,Beijing University of Chinese Medicine Third Affiliated Hospital,from July 2022 to August 2023.This group included 10 patients with bilateral conditions and 10 with unilateral,comprising 4 males and 16 females,with an average of 16.2±2.4 years(range,14-19 years).The procedure involved the release of the lateral capsule,sesamoid ligaments,and adductor hallucis before osteotomy.After osteotomy,shortening and wedge resection were performed,along with translation and rotation of the distal osteotomy to reposition the first metatarsal beside the sec-ond and thereby reduce metatarsus adductus.The outcomes included preoperative,immediate postoperative,and final follow-up angles:hallux valgus angle(HVA),intermetatarsal angle(IMA),metatarsal adduction angle(MAA),and the angle between the sec-ond to fifth metatarsals.Results All 20 patients successfully underwent surgery with good wound healing and no infections;the average clinical healing time of osteotomy site was 5.1±0.7 weeks(range,4.1-6.6 weeks).Follow-up lasted for 12.0±5.4 months(range,2-18 months).Significant differences were observed in HVA,which was from 35.40°±5.45° preoperatively to 6.93°±3.60° immediately postoperatively,and 9.83°±2.65° at final follow-up;IMA,which was from 11.50°(9.75°,14.00°)preoperatively to 1.50°(0.00°,2.00°)immediately postoperatively,and at final follow-up;MAA,which was from 22.80°±2.60° preoperatively to 20.63°±2.27° immediately postoperatively,and 20.67°±2.20° at final follow-up;the angle between the second to fifth metatarsals,which was from 19.03°±1.85° preoperatively to 15.37°±1.33° immediately postoperatively,and 16.03°±1.73° at final follow-up.Vi-sual analogue scale(VAS)also significantly decreased from 2.60±1.64 preoperatively to 1.30±0.92 at 6-8 weeks postoperatively.No cases of transfer metatarsalgia or recurrence of hallux valgus were reported.Conclusion The Scarf osteotomy for metatarsus adductus-type hallux valgus effectively corrects the first metatarsal adduction and improves the adduction state of the remaining metatarsals to various degrees.
关键词
青少年/外翻/截骨术Key words
Adolescent/Hallux valgus/Osteotomy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据