| 单切口Scarf旋转截骨联合外侧软组织松解术在中重度拇外翻畸形中的疗效分析 |
| Analysis of the efficacy of single-incision Scarf rotation osteotomy combined with lateral soft tissue release in moderate to severe hallux valgus deformity |
| 投稿时间：2024-05-11 |
| DOI：10.3969/j.issn.1672-5972.2025.02.001 |
| 中文关键词: 中重度拇外翻畸形 单切口 Scarf旋转截骨 外侧软组织松解 |
| 英文关键词:Moderate to severe hallux valgus deformity single incision Scarf rotation osteotomy lateral soft tissue release |
| 基金项目: |
| 作者 | 单位 | 邮编 | | 石守印* | 新疆维吾尔自治区人民医院骨科中心,新疆 乌鲁木齐,830001 | 830001 | | 周敏* | 新疆生产建设兵团医院神经外科,新疆 乌鲁木齐,830000 | 830000 | | 海拉提·巴合提 | 新疆维吾尔自治区人民医院骨科中心,新疆 乌鲁木齐,830001 | 830001 | | 孙俊刚 | 新疆维吾尔自治区人民医院骨科中心,新疆 乌鲁木齐,830001 | 830001 | | 徐江波 | 新疆维吾尔自治区人民医院骨科中心,新疆 乌鲁木齐,830001 | 830001 |
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| 中文摘要: |
| 目的 探讨采用单切口Scarf旋转截骨联合外侧软组织松解治疗中重度拇外翻的临床效果。方法 回顾性分析2016年1月至2022年1月新疆维吾尔自治区人民医院骨科中心收治的50例（62足）采用单切口Scarf旋转截骨联合外侧软组织松解治疗的中重度拇外翻畸形患者资料。其中，男3例，女47例；年龄24 ～ 77岁，平均（40.5±10.5）岁；左足18例，右足22例，双足11例。比较患者术前和术后末次随访时拇外翻角（hallux valgus angle, HVA），第1、2跖骨间角（intermetatarsal angle, IMA），远端关节面固有角（distal metatarsal articular angle, DMAA），并采用美国矫形足踝外科协会前足评分标准（American Orthopedic Foot and Ankle Society, AOFAS）及疼痛视觉模拟评分（visual analogue scale, VAS）评价疗效和术后并发症发生情况。结果 本组患者术后随访12 ～ 24个月，平均（12.0±3.2）个月，所有病例截骨部位均获得一期骨性愈合，术后矫形效果满意，无畸形复发、跖骨头坏死、拇内翻畸形等并发症，2例患者出现跖趾关节部分僵硬，1例患者术后5 d切口周围软组织出现红肿。末次随访时HVA、IMA、DMAA较术前明显降低，差异有统计学意义（P＜0.05）。末次随访时AOFAS评分较术前增加，VAS评分较术前降低，差异有统计学意义（P＜0.05）。术前AOFAS评分，优0足，良4足，可54足，差4足；末次随访时AOFAS评分，优55足，良5足，可2足，差0足；手术前后比较差异有统计学意义（P＜0.05）。结论 单切口Scarf旋转截骨联合外侧软组织松解治疗中重度拇外翻畸形，具有手术切口少、术后并发症少、影像学角度改善明显、患者满意度较高等特点，具有临床推广价值。 |
| 英文摘要: |
| Objective To investigate the clinical effect of Scarf rotation osteotomy combined with lateral soft tissue release through single incision in the treatment of moderate and severe hallux valgus.Methods A retrospective analysis was performed on the data of 50 patients (62 feet) with moderate to severe hallux valgus deformity who were treated with single-incision Scarf rotation osteotomy combined with lateral soft tissue release in the Orthopedic Center of the People's Hospital of Xinjiang Uygur Autonomous Region from January 2016 to January 2022. Among them, there were 3 males and 47 females, with an average age of (40.5±10.5) years old (range, 24-77 years old). There were 18 left feet, 22 right feet, and 11 feet of both sides. The hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and at the last follow-up after surgery. The American Orthopedic Foot and Ankle Society forefoot scoring criteria (AOFAS) and visual analogue scale (VAS) were used to evaluate the efficacy and postoperative complications.Results The patients in this group were followed up for 12 to 24 months after surgery, with an average of (12.0±3.2) months. All cases achieved primary bone union at the osteotomy site, and the postoperative correction effect was satisfactory, without complications such as deformity recurrence, metatarsal head necrosis, and hallux varus deformity. Two patients experienced partial stiffness of the metatarsophalangeal joints, but did not complain of other discomforts. One patient had redness and swelling of the soft tissue around the incision on the 5th day after surgery. The symptoms disappeared after the dressing was changed in the outpatient clinic. At the last follow-up, the HVA, IMA, DMAA were significantly improved after surgery compared with preoperative, and the difference was statistically significant (P<0.05). At the last follow-up, the AOFAS was significantly increased after surgery compared with preoperative, VAS was significantly decreased after surgery compared with preoperative, and the difference was statistically significant (P<0.05). Preoperative AOFAS score: excellent in 0 feet, good in 4 feet, fair in 54 feet poor in 4 feet, the AOFAS score at the last follow-up was excellent in 55 feet, good in 5 feet, fair in 2 feet, and poor in 0 feet, and the difference was statistically significant (P<0.05).Conclusion The single-incision Scarf rotation osteotomy combined with lateral soft tissue release for the treatment of moderate to severe hallux valgus deformity has the characteristics of fewer surgical incisions, fewer postoperative complications, significant improvement in imaging angles, and high patient satisfaction, and has clinical promotion value. |
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