截骨治疗青少年拇外翻两种固定效果的比较

发布时间：2018-03-31 15:56

本文选题：足拇外翻　切入点：第一跖骨　出处：《河北医科大学》2015年硕士论文

【摘要】：目的:通过比较青少年足拇外翻应用第1跖骨截骨矫形治疗术后,分别应用克氏针与接骨板两种方法固定截骨端的效果,找出那种固定方法效果更好。方法:回顾性研究2008年1月至2014年7月期间,共收治青少年拇外翻39例(72足),其中获得随访的患者共23例(40足),根据内固定方式不同将获得随访的患者分为A组、B组,A组用克氏针固定,B组用接骨板固定。每足术前及术后、末次随访时均拍摄足负重正侧位X线片,测量HVA和1~2IMA;根据AOFAS足拇趾、跖趾关节、趾间关节评分进行功能评估,并记录并发症发生情况。比较术前及术后、末次随访时拇外翻角(HVA)和1~2跖骨间角(IMA)及AOFAS评分评估患者功能愈后,选择SPSS 19.0进行数据统计,数据采用均数±标准差(c±s)来表示,均数的比较采用t检验,当P0.05时,差异具有统计学意义。结果:这两组患者中男性5例(8足),女性18例(32足);平均年龄17.3±3.4岁(11~24岁)。平均随访15.6个月(12~20个月),无感染和不愈合发生,有2例3足(7.5%)出现负重行走时第一跖趾关节下轻度疼痛,4例7足(17.5%)出现足拇外翻复发。A组:HVA由术前平均35.1°±2.7°减小至术后1天平均16.5°±1.6°(P0.01)、术后1年平均22.1°±3.0o(P0.01);1~2跖骨间角IMA由术前平均15.8°±2.5°减小至术后1天平均8.7°±0.7°(P0.01)、术后1年平均10.7°±0.7 o(P0.01);AOFAS评分由术前平均39.9±8.3分提高至术后1年平均87.3±4.7分(P0.01)。B组:HVA由术前平均35.6°±3.0°减小至术后1天平均16.6°±1.2°(P0.01)、术后1年平均18.7°±2.0o(P0.01);1~2跖骨间角IMA由术前平均15.7°±2.5°减小至术后1天平均8.9°±0.7°(P0.01)、术后1年平均9.8°±0.7o(P0.01);AOFAS评分由术前平均40.5±8.1分提高至术后1年平均94.0±4.3分(P0.01)。统计分析表明:克氏针组与接骨板组术前HVA(P=0.565)、IMA(P=0.911)、AOFAS评分无明显差异(P=0.818),术后1天二者HVA(P=0.737)、IMA(P=0.453)无明显差异,术后1年,克氏针组与接骨板组HVA(P0.05)、IMA(P0.05)、AOFAS评分(P0.05)均有差异。功能评级:A组优6足,良11足,差3足,优良率为85.5%;B组优12足,良7足,差1足,优良率为95%。结论:1青少年拇外翻患者行第一跖骨截骨矫形内固定术,手术疗效明显,能够明显的改善症状。2应用克氏针内固定和应用接骨板内固定的两组患者,在术后短期内效果无明显差异,术后1年差异明显,第1跖骨截骨端应用接骨板内固定效果要优于应用克氏针内固定。3无论克氏针内固定组还是接骨板内固定组,均有患者术后拇外翻复发,这说明青少年拇外翻术后易复发是其特点。
[Abstract]:Objective: to compare the effect of orthopedic osteotomy with Kirschner's needle and plate after the first metatarsal osteotomy in juvenile thumb valgus. Find out which fixation method works better. Method: a retrospective study from January 2008 to July 2014, A total of 39 cases (72 feet) of hallux valgus were treated. Among them, 23 cases (40 feet) were followed up. According to the different internal fixation methods, the patients in group A were divided into two groups: group A was fixed with Kirschner's needle and group B was fixed with bone plate according to the different internal fixation methods, and each foot was fixed with bone plate before and after operation. At the last follow-up, the positive and lateral radiographs of foot loading were taken to measure HVA and 1D IMA, the functional evaluation was made according to the scores of AOFAS's hallux, metatarsophalangeal and intercalcaneal joints, and the complications were recorded and compared before and after operation. After evaluating the functional recovery of patients with hallux valgus angle (HVA) and intermetatarsal angle (Iva) and AOFAS score, SPSS 19.0 was selected for data statistics. The data were expressed by mean 卤standard deviation (c 卤s). The mean value was compared with t test, when P0.05, the mean value was calculated. Results: the difference was statistically significant. Results: in the two groups, there were 5 males with 8 feet and 18 females with 32 feet with an average age of 17.3 卤3.4 years and 1124 years old. The mean follow-up period was 15.6 months, 12 ~ 20 months, and no infection or nonunion occurred. There were 2 cases (3 feet 7.5) with mild pain in the first metatarsophalangeal joint during weight-bearing walking. (4 cases with 17. 5 feet.) recurrence of hallux valgus occurred. Group A: HVA decreased from 35.1 掳卤2.7 掳before operation to 16.5 掳卤1.6 掳P0.01a on the first day after operation, and 1 year after operation, the average intermetatarsal angle IMA was 22.1 掳卤3.0oP 0.01a. The average AOFAS score in group B increased from 39.9 卤8.3 to 87.3 卤4.7 before operation to an average of 35.6 卤3.0 掳before operation to an average of 16.6 卤1.2 掳P0.01a at one day after operation, and an average of 18.7 掳卤2.0oP0.01 / 1 metatarsal bone at 1 year after operation in group B (P < 0.05) and in group B (n = 1), from 35.6 掳卤2.5 掳before operation to an average of 8.7 掳卤0.7 掳P0.01a on 1 day after operation. The average AOFAS score increased from 39.9 卤8.3 points before operation to 87.3 卤4.7 minutes before operation to an average of 16.6 掳卤1.2 掳P0.01a post operation one year after operation. The mean interangle IMA decreased from 15.7 掳卤2.5 掳before operation to 8.9 掳卤0.7 掳P0.01a on the first day after operation, and increased from 40.5 卤8.1 preoperatively to 94.0 卤4.3 P0.01in one year after operation. There was no significant difference between the two groups on the 1st day after operation, but there was no significant difference between the two groups on the first day after operation, but there was no significant difference between the two groups (P = 0.453). One year after operation, there was significant difference between the Kjeldahl needle group and the plate group (HVAN P0.05IMA P0.05 / AOFAS score P0.05). The functional score was excellent in 6 feet, good in 11 feet, poor in 3 feet in group A. the excellent and good rate was 85.5% in group B: excellent 12 feet, good in 7 feet, poor in 1 foot. Conclusion the first metatarsal osteotomy and orthopedic internal fixation is effective in the treatment of the first metatarsal osteotomy, and can significantly improve the symptoms of the two groups. 2. The two groups were treated with Kirschner's needle and plate fixation. There was no significant difference in the results in the short term after operation, but there was a significant difference at one year after operation. The effect of using the first metatarsal osteotomy was better than that of using Kirschner's needle internal fixation. 3. Either the Kirschner wire internal fixation group or the plate internal fixation group were better than those of the first metatarsal osteotomy group. All patients had recurrence of hallux valgus, which indicated that the recurrence of juvenile hallux valgus was a characteristic.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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