青少年拇外翻的相关基础及临床治疗研究

发布时间：2018-03-11 18:40

本文选题：拇外翻角　切入点：跖间角　出处：《河北医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：通过比较测量青少年拇外翻、成年人拇外翻和足趾正常青少年拇外翻角、跖间角及跖楔关节活动度、AOFAS评分，找到青少年拇外翻的病理特点，以此为理论基础，分别采用跖骨远端截骨矫形术、跖骨基底截骨矫形术、跖楔关节融合术治疗不同病理基础的青少年拇外翻患者，观察其术后疗效如何，从而找到个性化治疗青少年拇外翻的有效方法。方法 2005年6月—2010年6月，收治青少年拇外翻60例111足。 1、选取取青少年拇外翻病例30例57足，成人拇外翻病例30例56足，足趾正常青少年30例60足，每足均拍摄足正侧位X线片，测量其拇外翻角、跖间角、跖楔关节活动度。根据美国足踝协会第1跖趾关节评分标准得出三组AOFAS评分。采用spss13.0统计分析软件对组数值进行多样本方差分析 2、选取跖间角大于15度青少年患者30人55足，将其随机分为a、b两组，a组15例27足，b组15例28足，术前测量两组跖间角、拇外翻角，跖楔关节活动度，AOFAS评分，采用spss13.0统计分析软件比较两组各向数值有无统计学差异， a组采用跖骨远端截骨矫形术。b组采用跖骨远端截骨加跖骨基底截骨术，术后随访测量拇外翻角、跖间角、AOFAS评分。术后采用spss13.0统计分析软件对各组数值进行独立样本T检验。 3、将跖楔关节活动度大的青少年患者随机分为C、D组，C组15例30足，D组15例26足。术前测量两组跖间角、拇外翻角、AOFAS评分、跖楔关节活动度，采用spss13.0统计分析软件比较两组跖间角有无统计学差异，C组采用跖骨远端截骨矫形术，D组采用跖骨远端截骨矫形加跖楔关节融合术，术后随访测量跖间角、拇外翻角、AOFAS评分。术后采用spss13.0统计分析软件对各组数值进行独立样本T检验。结果 1、青少年拇外翻患者拇外翻角为39.39±1.16度、跖间角为14.14±0.36度、跖楔关节活动度为21±0.36mm，AOFAS评分为88.44±0.46；成年人拇外翻患者拇外翻角为35.43±0.99度、跖间角为12.50±0.33度、跖楔关节活动度为18.63±0.49mm，AOFAS评分为70.41±0.90，足趾正常青少年拇外翻角为5.73±0.33度、跖间角为3.8±0.22度、跖楔关节活动度为11.78±0.46mm，AOFAS评分为100±0.00。 2、a组拇外翻角为39.0±1.5度，跖间角为15.92±0.21度，跖楔关节活动度为22±0.28mm，AOFAS评分为86.19±1.44。b组拇外翻角为40.2±2.18度，跖间角为15.89±0.44度，跖楔关节活动度为21.93±0.32mm，AOFAS评分为87.89±1.12。术后a组拇外翻角为15.00±0.46度，跖间角为15.92±0.21度，AOFAS评分为86.19±1.44，b组拇外翻角为11.54±0.51度，跖间角为9.75±0.59度，AOFAS评分为96.96±0.95。 3、跖楔关节活动度大的患者, C组拇外翻角为41.07±1.11度，，跖间角为15.13±0.42度，跖楔关节活动度为21.93±0.32mm，AOFAS评分为85.8±1.2。D组拇外翻角为40.42±2.15度；跖间角为15.50±0.51度，跖楔关节活动度为22±0.28mm，AOFAS评分为87.11±1.16。术后C组拇外翻角为16.47±0.45度，跖间角为15.13±0.42度，AOFAS评分89.6±1.17；D组拇外翻角为12.46±0.51度，跖间角为8.30±0.52度，AOFAS评分94.62±1.18。 4、对各组拇外翻角、跖间角、跖楔关节活动度、AOFAS评分进行统计学分析。 4.1青少年、成年人、足趾正常青少年三组各项数值方差分析统计量为:拇外翻角三组比较有统计学差异F为440.02，P 0.05，两两比较拇外翻角有统计学差异;跖间角三组比较有统计学差异F为342.22，P 0.05，两两比较跖间角有统计学差异;跖楔关节活动度三组比较有统计学差异为F为116.397，P 0.05，两两比较跖楔关节活动度有统计学差异;AOFAS评分三组比较有统计学差异F为685.53，P 0.05，两两比较AOFAS评分有统计学差异。 4.2.1a、b两组术前各项数值T检验统计量为：拇外翻角两组无统计学差异t为-0.455，P=0.651；跖间角两组无统计学差异t为0.067，P=0.947；跖楔关节活动度两组无统计学差异t为0.168，P=0.867；AOFAS评分两组无统计学差异t为-0.940,P=0.352。 4.2.2a、b两组术后各项数值T检验统计量为：拇外翻角a组高于b组t为5.02,P 0.05；跖间角a组高于b组t为9.56，P 0.05；AOFAS评分b组高于a组t为-6.296, P 0.05。 4.3.1C、D两组术前各项数值T检验统计量为：拇外翻角两组无统计学差异t为0.276，P=0.783；跖间角两组无统计学差异t为-0.56，P=0.579；跖楔关节活动度两组无统计学差异t为-0.156，P=0.876；AOFAS评分两组无统计学差异t为0.781，P=0.438。 4.3.2C、D两组术后各项数值T检验统计量为：拇外翻角C组高于D组t为5.88，P 0.05；跖间角C组高于D组t为10.32，P 0.05；AOFAS评分D组高于C组t为-3.00，P 0.05。结论 1、青少年拇外翻患者、成年人拇外翻患者足趾正常青少年，拇外翻角、跖间角、跖楔关节活动度、AOFAS评分比较有统计学差异，青少年拇外翻患者拇外翻角、跖间角、跖楔关节活动度均大于成年人拇外翻患者和足趾正常青少年，但AOFAS评分小于足趾正常青少年大于成年人患者。 2、跖间角大于15度青少年患者跖骨远端截骨加跖骨基底截骨术组拇外翻角、跖间角、AOFAS评分与单纯远端截骨术组比较有统计学差异。远端截骨加跖骨基底截骨术组拇外翻角、跖间角均低于单纯远端截骨术组，但AOFAS评分高于单纯远端截骨术组。对于这部分患者应行跖骨远端截骨加跖骨基底截骨矫形术。 3、跖楔关节活动度大的青少年患者跖骨远端截骨加跖楔关节融合术组拇外翻角、跖间角，AOFAS评分与单纯远端截骨术组比较有统计学差异，远端截骨加跖楔关节融合术组拇外翻角、跖间角，均低于单纯远端截骨术组，但AOFAS评分高于单纯远端截骨术组。对于这部分患者应行跖骨远端截骨加跖楔关节融合术。
[Abstract]:Objective: To compare the measurement of adolescent hallux valgus, adults and adolescents with normal toe hallux valgus hallux valgus angle, intermetatarsal angle and tarsometatarsal joint activity, AOFAS score, find the pathological features of adolescent hallux valgus, based on this theory, using distal metatarsal osteotomy for orthopedic surgery, metatarsal osteotomy, plantar wedge arthrodesis in the treatment of different pathological basis of adolescent hallux valgus patients, to observe the curative effect after operation, in order to find effective method for personalized treatment of adolescent hallux valgus.
Method
From June 2005 to June 2010, 60 cases of 111 feet of juvenile hallux valgus were treated.
1, a selection of 30 cases of adolescent hallux valgus in 57 cases, 30 cases of adult hallux valgus foot 56 toes, 30 normal children and adolescents 60 feet, each foot and foot were taken lateral X-ray measurement, the hallux valgus angle, intermetatarsal angle, tarsometatarsal joint activity. According to the American Association of the first metatarsophalangeal ankle the joint standard for evaluation of AOFAS scores of the three groups. Using SPSS13.0 statistical analysis software for numerical analysis of multi sample variance group
2, select the intermetatarsal angle greater than 15 degrees in 30 adolescent patients in 55 cases, which were randomly divided into a, B two groups, a group of 15 cases in 27 cases, 15 cases in B group 28 cases, preoperative measurement of two intermetatarsal angle, hallux valgus angle, tarsometatarsal joint activity, AOFAS score, the SPSS13.0 statistical analysis software to the numerical comparison between the two groups have no statistical difference, a group with distal metatarsal osteotomy group.B with distal metatarsal osteotomy and metatarsal osteotomy, postoperative follow-up measurement of hallux valgus angle, intermetatarsal angle, AOFAS score after operation. Using SPSS13.0 statistical analysis software for T test of independent samples each value.
3, the tarsometatarsal joint activity in adolescent patients were randomly divided into C, D group, C group of 15 cases in 30 cases, D group of 15 cases 26 feet. Preoperative measurement of two intermetatarsal angle, hallux valgus angle, AOFAS score, tarsometatarsal joint activity, using SPSS13.0 statistical analysis software were compared between the two groups intermetatarsal angle have no statistical difference, C group with distal metatarsal osteotomy, D treated by distal osteotomy plus tarsometatarsal arthrodesis, postoperative follow-up measurement intermetatarsal angle, hallux valgus angle and AOFAS score after operation. Using SPSS13.0 statistical analysis software for independent samples T test on each value.
Result
1 young patients with hallux valgus hallux valgus angle was 39.39 + 1.16, 14.14 + 0.36 intermetatarsal angle of tarsometatarsal joint activity was 21 + 0.36mm, the AOFAS score was 88.44 + 0.46; adult patients with hallux valgus hallux valgus angle was 35.43 + 0.99 degrees, intermetatarsal angle was 12.50 + 0.33 degrees, plantar wedge joint activity was 18.63 + 0.49mm, the AOFAS score was 70.41 + 0.90, toe normal adolescent hallux valgus angle was 5.73 + 0.33, 3.8 + 0.22 intermetatarsal angle of tarsometatarsal joint activity was 11.78 + 0.46mm, the AOFAS score was 100 + 0.00.
2, in group A, the hallux valgus angle is 39 + 1.5 degrees, the inter plantar angle is 15.92 + 0.21 degrees, the activity of the wedge-shaped joint is 22 + 0.28mm, the AOFAS score is 86.19 + 1.44.b, the hallux valgus angle is 40.2 + 2.18 degrees, the plantar angle is 15.89 15.89, the activity of the wedge-shaped joint is 0.32mm, and the AOFAS score is 15.89 + 1.12..
After operation, the hallux valgus angle in group A was 15 + 0.46 degrees, the inter plantar angle was 15.92 + 0.21 degrees, and the AOFAS score was 86.19 + 1.44. In group B, the hallux valgus angle was 11.54 + 0.51 degrees, and the plantar angle was 9.75 9.75. 0.59, and the AOFAS score was 96.96 + 0.95..
3 patients with tarsometatarsal joint activity degree of C group, hallux valgus angle was 41.07 + 1.11, 15.13 + 0.42 intermetatarsal angle of tarsometatarsal joint activity was 21.93 + 0.32mm, the AOFAS score was 85.8 + 1.2.D group of hallux valgus angle was 40.42 + 2.15; 15.50 + 0.51 intermetatarsal angle degree of tarsometatarsal joint activity was 22 + 0.28mm, the AOFAS score was 87.11 + 1.16.
After operation, the hallux valgus angle in group C was 16.47 + 0.45 degrees, the inter plantar angle was 15.13 + 0.42 degrees, and the AOFAS score was 89.6 + 1.17. In group D, the hallux valgus angle was 12.46 + 0.51 degrees, and the plantar angle was 8.30 8.30. 0.52, and the AOFAS score was 94.62 1.18..
4, the AOFAS score was statistically analyzed for the angle of hallux valgus, the angle of the metatarsal, and the activity of the metatarsal wedge.
4.1 teenagers, adults, adolescents with normal toe three groups of the numerical analysis of variance statistics for hallux valgus angle were significantly different between three groups F 440.02, P 0.05, 22 hallux valgus angle intermetatarsal angle have significant difference; there was statistical difference between three groups was 342.22 F, 0.05 P, 22 intermetatarsal angle statistical difference; tarsometatarsal joint activity were significantly different between three groups of F 116.397, P 0.05, 22 tarsometatarsal joint activity had significant difference; AOFAS scores were significantly different between three groups F 685.53, P 0.05, 22 had significant difference compared AOFAS score.
4.2.1a, B two group before the numerical T test statistic for hallux valgus angle no statistical difference between the two groups t -0.455, P=0.651 intermetatarsal angle; no statistical difference between the two groups was 0.067 T, P=0.947; tarsometatarsal joint activity no statistical difference between the two groups t 0.168, P=0.867 two; AOFAS score was not statistically the difference of t -0.940, P=0.352.
4.2.2a, B two groups of postoperative numerical T test statistics: the hallux valgus angle a group was higher than the B group, t was 5.02, P 0.05; the metatarsal angle a group was higher than the B group, t was 9.56, P 0.05; the B score was higher than that of the control group.
4.3.1C, D two group before the numerical T test statistic for hallux valgus angle no statistical difference between the two groups was 0.276 T, P=0.783 intermetatarsal angle; no statistical difference between the two groups T, -0.56, P=0.579; tarsometatarsal joint activity no statistical difference between the two groups t -0.156, P=0.876; the AOFAS scores of the two groups was not statistically the difference of T was 0.781, P=0.438.
4.3.2C, D two groups of postoperative numerical T test statistics: the hallux valgus angle C group was higher than the D group, t was 5.88, P 0.05; the metatarsal angle C group was higher than the D group, t was 10.32, P 0.05; the D score was higher than that of the control group.
conclusion
1 juvenile hallux valgus patients, adult patients with hallux valgus toe normal teenagers, hallux valgus angle, intermetatarsal angle, tarsometatarsal joint activity and AOFAS score were statistically differences, adolescent patients with hallux valgus hallux valgus angle, intermetatarsal angle, tarsometatarsal joint activity were higher than adult patients with hallux valgus toe and normal adolescents but, AOFAS score less than normal adolescents than adults toe patients.
2, intermetatarsal angle greater than 15 degrees in adolescent patients with distal metatarsal osteotomy plus metatarsal osteotomy group of hallux valgus angle, intermetatarsal angle, AOFAS score and simple distal osteotomy group were significantly different. The distal osteotomy and metatarsal osteotomy group of hallux valgus angle, intermetatarsal angle osteotomy group were lower than that of Dan Chunyuan, but the score of AOFAS higher than the distal osteotomy group. For this part of patients with distal metatarsal osteotomy with metatarsal osteotomy.
3, tarsometatarsal joint activity degree of adolescent patients with distal metatarsal osteotomy and tarsometatarsal arthrodesis group of hallux valgus angle, intermetatarsal angle, AOFAS score and simple distal osteotomy group were significantly different, the distal osteotomy and tarsometatarsal arthrodesis group of hallux valgus angle, intermetatarsal angle, were lower than the pure distal osteotomy group, but AOFAS score higher than the distal osteotomy group. For this part of patients with distal metatarsal osteotomy and tarsometatarsal arthrodesis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R687.3

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