微创跖骨头颈截骨抬高术治疗无脱位型跖痛症临床疗效初探
发布时间：2019-02-21 17:54
【摘要】：1目的探讨微创跖骨头颈截骨抬高术治疗无脱位型跖痛症的临床疗效。2方法从2013年6月至2015年3月,于中国中医科学院望京医院骨关节二科接受微创跖骨头颈截骨抬高术治疗无脱位型跖痛症患者,经长期随访资料完整者24例26足,共55个跖骨,左足17,右足9(纳入28例32足,脱落4例6足,脱落病例均为失访所致)其中男3例3足,女21例23足；年龄47岁一78岁,平均56.3岁。采用微创跖骨头颈截骨抬高术治疗,第二跖骨21个、第三跖骨21个、第四跖骨13个,随访时间6月-18月,平均13月。受试者均于手术前及手术后3个月、6个月、12个月的时间内测量记录责任趾跖趾关节活动度、视觉模拟量表(VAS)评分、责任跖骨头下的压痛指数,采用美国足踝医师学会前足评分系统(ACFAS)对受试者进行评估,同时使用Footscan足底压力分析仪测量并且记录正常行走步态周期中相应跖骨头下所承受最大压力、最大压强及冲量的前后变化,并且拍摄患者足部X线片包括负重与非负重位片,并对其中的指标进行临床研究,术前告诉患者详情,签署知情同意书,符合病例纳入条件,无手术禁忌症的患者纳入本研究中。为确立病例纳入质量,由三名副高职称及以上从事足踝外科的专家评定病例的纳入,采取简单多数原则,对于有争议的进行三方协商确定,最后符合x线分度为0-1度的病例纳入本研究。3结果微创跖骨头颈截骨抬高术治疗无脱位型跖痛症VAS评分术前为(4.23±0.96)分,术后为(1.55±1.05)分,ACFAS评分术前为(56.47±8.16)分,术后为(84.51±4.39)分,压痛指数术前为(2.09±0.67)分,术后为(0.38±0.49)差异均有统计学意义(P0.05)；责任跖趾关节活动度术前为(57.42±8.41)度,术后为(31.07±6.34)责任跖骨头下最大压力术前为(136.25±19.42)N,术后为(75.13±13.87)N,最大压强术前为(15.15±2.34)cm2,术后为(9.25±2.63)cm2,冲量术前为(49.70±12.09)Ns,术后为(23.95±6.59)Ns,差异均有统计学意义(P0.05)。术后转移性跖骨头下疼痛2例,占3.63%,术后跖骨无骨折不愈合；截骨端延迟愈合4例跖骨7.27%,其中第二跖骨2例,第三跖骨1例,第四跖骨1例,嘱其减少负重,口服补肾壮骨中药颗粒剂后均于术后7-11个月内愈合。术后足跖皮肤麻木3足,占11.53%,未经特殊处理,于术后3-5个月内恢复正常皮肤感觉。本组研究中未出现足趾切口皮肤坏死、足部软组织感染、胼胝体复发、深静脉血栓等其他并发症。4结论基于跖痛症X线分度标准确定的微创跖骨头颈截骨抬高术治疗无脱位型跖痛症(X线分度0-1度),可明显改善跖骨头下疼痛症状,对于临床治疗有指导意义。
[Abstract]:Objective to investigate the clinical effect of minimally invasive metatarsal head and neck osteotomy in the treatment of non-dislocation metatarsal pain. 2 methods from June 2013 to March 2015, Patients with non-dislocation metatarsal pain were treated with minimally invasive osteotomy of metatarsal head and neck in the second Department of Bone and Joint, Wangjing Hospital, Chinese Academy of traditional Chinese Medicine. Twenty-six patients (55 metatarsal and 17 left foot) were followed up for a long time. 9 right feet (including 32 feet in 28 cases and 6 feet in 4 cases), including 3 male (3 feet) and 21 women (23 feet); The age ranged from 47 years to 78 years, with an average of 56.3 years. The second metatarsal bone 21 the third metatarsal 21 and the fourth metatarsal 13 were treated by minimally invasive osteotomy of the head and neck of metatarsal. The follow-up time was 6 months to 18 months (mean 13 months). The movement of the responsible metatarsophalangeal joint, the (VAS) score of visual analogue scale, and the tenderness index under the head of the responsible metatarsal bone were measured before and after operation for 3 months, 6 months and 12 months after operation. The subjects were evaluated using the American Academy of ankle Physicians' forefoot scoring system (ACFAS), and the maximum pressure under the metatarsal head during the normal gait cycle was measured and recorded by the Footscan plantar pressure analyzer. The changes of the maximum pressure and impulse, and the X-ray film of the patient's foot, including weight-bearing and non-weight-bearing, were taken, and the clinical study was carried out. The patients were told the details before operation, and informed consent was signed, which met the condition of inclusion of the case. Patients without contraindications were included in this study. In order to establish the quality of the case inclusion, the inclusion of the case was assessed by three experts with sub-high professional titles and above engaged in foot and ankle surgery. The principle of simple majority was adopted, and the controversial cases were determined through tripartite consultation. Results the VAS score of minimally invasive metatarsal head and neck osteotomy in the treatment of non-dislocation metatarsal pain was (4.23 卤0.96) before operation and (1.55 卤1.05) after operation. ACFAS score was (56.47 卤8.16) points before operation, (84.51 卤4.39) points after operation, (2.09 卤0.67) points before operation and (0.38 卤0.49) points after operation (P0.05). The range of motion of the metatarsophalangeal joint was (57.42 卤8.41) before operation, (31.07 卤6.34) before operation and (136.25 卤19.42) N under the head of the responsible metatarsal, and (75.13 卤13.87) N after operation. The maximum pressure was (15.15 卤2.34) cm2, and (9.25 卤2.63) cm2, impulse before and after (49.70 卤12.09) Ns, and (23.95 卤6.59) Ns, respectively (P0.05). Postoperative metastatic metatarsal head pain occurred in 2 cases (3.63%). There was no nonunion of metatarsal bone. Delayed healing of metatarsal bone in 4 cases was delayed in 4 cases, including the second metatarsal in 2 cases, the third metatarsal in 1 case and the fourth metatarsal in 1 case. Postoperatively, 3 feet (11.53%) became numb to the plantar skin and recovered normal skin sensation within 3 to 5 months without special treatment. No skin necrosis, soft tissue infection, recurrence of corpus callosum were found in this study. Conclusion the minimally invasive metatarsal head and neck osteotomy based on the radiographic grading criteria of metatarsal pain can significantly improve the symptoms of submetatarsal head pain in the treatment of non-dislocation metatarsal pain (X-ray score 0-1 degree). It has guiding significance for clinical treatment.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2427747
[Abstract]:Objective to investigate the clinical effect of minimally invasive metatarsal head and neck osteotomy in the treatment of non-dislocation metatarsal pain. 2 methods from June 2013 to March 2015, Patients with non-dislocation metatarsal pain were treated with minimally invasive osteotomy of metatarsal head and neck in the second Department of Bone and Joint, Wangjing Hospital, Chinese Academy of traditional Chinese Medicine. Twenty-six patients (55 metatarsal and 17 left foot) were followed up for a long time. 9 right feet (including 32 feet in 28 cases and 6 feet in 4 cases), including 3 male (3 feet) and 21 women (23 feet); The age ranged from 47 years to 78 years, with an average of 56.3 years. The second metatarsal bone 21 the third metatarsal 21 and the fourth metatarsal 13 were treated by minimally invasive osteotomy of the head and neck of metatarsal. The follow-up time was 6 months to 18 months (mean 13 months). The movement of the responsible metatarsophalangeal joint, the (VAS) score of visual analogue scale, and the tenderness index under the head of the responsible metatarsal bone were measured before and after operation for 3 months, 6 months and 12 months after operation. The subjects were evaluated using the American Academy of ankle Physicians' forefoot scoring system (ACFAS), and the maximum pressure under the metatarsal head during the normal gait cycle was measured and recorded by the Footscan plantar pressure analyzer. The changes of the maximum pressure and impulse, and the X-ray film of the patient's foot, including weight-bearing and non-weight-bearing, were taken, and the clinical study was carried out. The patients were told the details before operation, and informed consent was signed, which met the condition of inclusion of the case. Patients without contraindications were included in this study. In order to establish the quality of the case inclusion, the inclusion of the case was assessed by three experts with sub-high professional titles and above engaged in foot and ankle surgery. The principle of simple majority was adopted, and the controversial cases were determined through tripartite consultation. Results the VAS score of minimally invasive metatarsal head and neck osteotomy in the treatment of non-dislocation metatarsal pain was (4.23 卤0.96) before operation and (1.55 卤1.05) after operation. ACFAS score was (56.47 卤8.16) points before operation, (84.51 卤4.39) points after operation, (2.09 卤0.67) points before operation and (0.38 卤0.49) points after operation (P0.05). The range of motion of the metatarsophalangeal joint was (57.42 卤8.41) before operation, (31.07 卤6.34) before operation and (136.25 卤19.42) N under the head of the responsible metatarsal, and (75.13 卤13.87) N after operation. The maximum pressure was (15.15 卤2.34) cm2, and (9.25 卤2.63) cm2, impulse before and after (49.70 卤12.09) Ns, and (23.95 卤6.59) Ns, respectively (P0.05). Postoperative metastatic metatarsal head pain occurred in 2 cases (3.63%). There was no nonunion of metatarsal bone. Delayed healing of metatarsal bone in 4 cases was delayed in 4 cases, including the second metatarsal in 2 cases, the third metatarsal in 1 case and the fourth metatarsal in 1 case. Postoperatively, 3 feet (11.53%) became numb to the plantar skin and recovered normal skin sensation within 3 to 5 months without special treatment. No skin necrosis, soft tissue infection, recurrence of corpus callosum were found in this study. Conclusion the minimally invasive metatarsal head and neck osteotomy based on the radiographic grading criteria of metatarsal pain can significantly improve the symptoms of submetatarsal head pain in the treatment of non-dislocation metatarsal pain (X-ray score 0-1 degree). It has guiding significance for clinical treatment.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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