【摘要】 目的运用前瞻性队列研究探索应用拉力螺钉和锁定钢板固定第一跖骨近端斜形截骨治疗拇外翻的临床疗效和并发症情况。方法自2008年5月至2010年4月,所有本院第一跖间角(IMA)大于16°的拇外翻手术患者纳入本研究。患者的术前、术后评估采用美国足踝外科协会评分标准(AOFAS)评分。共有63例患者的71足纳入本研究,其中44例患者(69.84%)使用拉力螺钉固定,19例患者(30.16%)使用锁定钢板。所有患者的平均年龄为(57.5±13.7)岁。结果两组的年龄、术前和术后的AOFAS评分均无统计学差异。螺钉组的随访AOFAS评分平均为78.9±13.6,而钢板组为73.3±19.0(P<0.05),且两组的术后AOFAS评分较术前均有显著改变,差别具有统计学意义(P<0.05)。在全部病例中,有7例患者(11.11%)拇外翻复发,其中6例(9.52%)是螺钉组,1例(1.59%)是钢板组。在7例复发的患者中,全部是大于60岁的老年人。结论在IMA大于16°的拇外翻患者的治疗中,使用锁定钢板和拉力螺钉对第一跖骨近端斜形截骨进行固定后的临床疗效和并发症情况无明显差异,长期结果有待于进一步随访。更多还原

【Abstract】 Objective A prospective cohort study of the proximal oblique osteotomy of first metatarsal, stabilized w ith either lag screw s or a locking plate,w as undertaken to investigate the efficiency and complications. Methods From M ay 2008 to April 2010,involving patients w ere treated for hallux valgus w ith IM A greater than 16. All patients w ere assessed using the American Orthopaedic Foot and Ankle Society( AOFAS) score before and after surgery. The cohort included 71 procedures in 63 patients,44( 69. 84%) of w hich w ere xated w ith lag screw s and 19( 30. 16%) with locking plates. The overall mean patient age was( 57. 5 ± 13. 7) years. Results No statistically signicant differences w ere found betw een the xation groups relative to age,preoperative and postoperative AOFAS scores. Postoperatively,the mean AOFAS score for the lag screw group w as 78. 9 ± 13. 6 and that for the locking plate group w as 73. 3 ± 19. 0( P < 0. 05). In both groups,the AOFAS scores improved signicantly( P <. 005) after surgery. Overall,7( 11. 11%) recurrent hallux valgus deformities w ere observed,6( 9. 52%) in the lag screw group and 1( 1. 59%) in the locking plate group. All of the 7 recurrences w ere older than 60 years. Conclusion In the treatment of hallux valgus w ith IM A greater than 16,there is no significant difference in clinical efficacy and complicationsw ith proximal oblique osteotomy of the first metatarsal stabilized by lag screw s and locking plate. Further follow-up is needed to get the long-term results.更多还原