本文選題：拇外翻角　切入點(diǎn)：跖間角　出處：《河北醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過比較測(cè)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、跖間角及跖楔關(guān)節(jié)活動(dòng)度、AOFAS評(píng)分，找到青少年拇外翻的病理特點(diǎn)，以此為理論基礎(chǔ)，分別采用跖骨遠(yuǎn)端截骨矯形術(shù)、跖骨基底截骨矯形術(shù)、跖楔關(guān)節(jié)融合術(shù)治療不同病理基礎(chǔ)的青少年拇外翻患者，觀察其術(shù)后療效如何，從而找到個(gè)性化治療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、選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，每足均拍攝足正側(cè)位X線片，測(cè)量其拇外翻角、跖間角、跖楔關(guān)節(jié)活動(dòng)度。根據(jù)美國足踝協(xié)會(huì)第1跖趾關(guān)節(jié)評(píng)分標(biāo)準(zhǔn)得出三組AOFAS評(píng)分。采用spss13.0統(tǒng)計(jì)分析軟件對(duì)組數(shù)值進(jìn)行多樣本方差分析 2、選取跖間角大于15度青少年患者30人55足，將其隨機(jī)分為a、b兩組，a組15例27足，b組15例28足，術(shù)前測(cè)量兩組跖間角、拇外翻角，跖楔關(guān)節(jié)活動(dòng)度，AOFAS評(píng)分，采用spss13.0統(tǒng)計(jì)分析軟件比較兩組各向數(shù)值有無統(tǒng)計(jì)學(xué)差異， a組采用跖骨遠(yuǎn)端截骨矯形術(shù)。b組采用跖骨遠(yuǎn)端截骨加跖骨基底截骨術(shù)，術(shù)后隨訪測(cè)量拇外翻角、跖間角、AOFAS評(píng)分。術(shù)后采用spss13.0統(tǒng)計(jì)分析軟件對(duì)各組數(shù)值進(jìn)行獨(dú)立樣本T檢驗(yàn)。 3、將跖楔關(guān)節(jié)活動(dòng)度大的青少年患者隨機(jī)分為C、D組，C組15例30足，D組15例26足。術(shù)前測(cè)量兩組跖間角、拇外翻角、AOFAS評(píng)分、跖楔關(guān)節(jié)活動(dòng)度，采用spss13.0統(tǒng)計(jì)分析軟件比較兩組跖間角有無統(tǒng)計(jì)學(xué)差異，C組采用跖骨遠(yuǎn)端截骨矯形術(shù)，D組采用跖骨遠(yuǎn)端截骨矯形加跖楔關(guān)節(jié)融合術(shù)，術(shù)后隨訪測(cè)量跖間角、拇外翻角、AOFAS評(píng)分。術(shù)后采用spss13.0統(tǒng)計(jì)分析軟件對(duì)各組數(shù)值進(jìn)行獨(dú)立樣本T檢驗(yàn)。 結(jié)果 1、青少年拇外翻患者拇外翻角為39.39±1.16度、跖間角為14.14±0.36度、跖楔關(guān)節(jié)活動(dòng)度為21±0.36mm，AOFAS評(píng)分為88.44±0.46；成年人拇外翻患者拇外翻角為35.43±0.99度、跖間角為12.50±0.33度、跖楔關(guān)節(jié)活動(dòng)度為18.63±0.49mm，AOFAS評(píng)分為70.41±0.90，足趾正常青少年拇外翻角為5.73±0.33度、跖間角為3.8±0.22度、跖楔關(guān)節(jié)活動(dòng)度為11.78±0.46mm，AOFAS評(píng)分為100±0.00。 2、a組拇外翻角為39.0±1.5度，跖間角為15.92±0.21度，跖楔關(guān)節(jié)活動(dòng)度為22±0.28mm，AOFAS評(píng)分為86.19±1.44。b組拇外翻角為40.2±2.18度，跖間角為15.89±0.44度，跖楔關(guān)節(jié)活動(dòng)度為21.93±0.32mm，AOFAS評(píng)分為87.89±1.12。 術(shù)后a組拇外翻角為15.00±0.46度，跖間角為15.92±0.21度，AOFAS評(píng)分為86.19±1.44，b組拇外翻角為11.54±0.51度，跖間角為9.75±0.59度，AOFAS評(píng)分為96.96±0.95。 3、跖楔關(guān)節(jié)活動(dòng)度大的患者, C組拇外翻角為41.07±1.11度，，跖間角為15.13±0.42度，跖楔關(guān)節(jié)活動(dòng)度為21.93±0.32mm，AOFAS評(píng)分為85.8±1.2。D組拇外翻角為40.42±2.15度；跖間角為15.50±0.51度，跖楔關(guān)節(jié)活動(dòng)度為22±0.28mm，AOFAS評(píng)分為87.11±1.16。 術(shù)后C組拇外翻角為16.47±0.45度，跖間角為15.13±0.42度，AOFAS評(píng)分89.6±1.17；D組拇外翻角為12.46±0.51度，跖間角為8.30±0.52度，AOFAS評(píng)分94.62±1.18。 4、對(duì)各組拇外翻角、跖間角、跖楔關(guān)節(jié)活動(dòng)度、AOFAS評(píng)分進(jìn)行統(tǒng)計(jì)學(xué)分析。 4.1青少年、成年人、足趾正常青少年三組各項(xiàng)數(shù)值方差分析統(tǒng)計(jì)量為:拇外翻角三組比較有統(tǒng)計(jì)學(xué)差異F為440.02，P 0.05，兩兩比較拇外翻角有統(tǒng)計(jì)學(xué)差異;跖間角三組比較有統(tǒng)計(jì)學(xué)差異F為342.22，P 0.05，兩兩比較跖間角有統(tǒng)計(jì)學(xué)差異;跖楔關(guān)節(jié)活動(dòng)度三組比較有統(tǒng)計(jì)學(xué)差異為F為116.397，P 0.05，兩兩比較跖楔關(guān)節(jié)活動(dòng)度有統(tǒng)計(jì)學(xué)差異;AOFAS評(píng)分三組比較有統(tǒng)計(jì)學(xué)差異F為685.53，P 0.05，兩兩比較AOFAS評(píng)分有統(tǒng)計(jì)學(xué)差異。 4.2.1a、b兩組術(shù)前各項(xiàng)數(shù)值T檢驗(yàn)統(tǒng)計(jì)量為：拇外翻角兩組無統(tǒng)計(jì)學(xué)差異t為-0.455，P=0.651；跖間角兩組無統(tǒng)計(jì)學(xué)差異t為0.067，P=0.947；跖楔關(guān)節(jié)活動(dòng)度兩組無統(tǒng)計(jì)學(xué)差異t為0.168，P=0.867；AOFAS評(píng)分兩組無統(tǒng)計(jì)學(xué)差異t為-0.940,P=0.352。 4.2.2a、b兩組術(shù)后各項(xiàng)數(shù)值T檢驗(yàn)統(tǒng)計(jì)量為：拇外翻角a組高于b組t為5.02,P 0.05；跖間角a組高于b組t為9.56，P 0.05；AOFAS評(píng)分b組高于a組t為-6.296, P 0.05。 4.3.1C、D兩組術(shù)前各項(xiàng)數(shù)值T檢驗(yàn)統(tǒng)計(jì)量為：拇外翻角兩組無統(tǒng)計(jì)學(xué)差異t為0.276，P=0.783；跖間角兩組無統(tǒng)計(jì)學(xué)差異t為-0.56，P=0.579；跖楔關(guān)節(jié)活動(dòng)度兩組無統(tǒng)計(jì)學(xué)差異t為-0.156，P=0.876；AOFAS評(píng)分兩組無統(tǒng)計(jì)學(xué)差異t為0.781，P=0.438。 4.3.2C、D兩組術(shù)后各項(xiàng)數(shù)值T檢驗(yàn)統(tǒng)計(jì)量為：拇外翻角C組高于D組t為5.88，P 0.05；跖間角C組高于D組t為10.32，P 0.05；AOFAS評(píng)分D組高于C組t為-3.00，P 0.05。 結(jié)論 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、跖間角、跖楔關(guān)節(jié)活動(dòng)度、AOFAS評(píng)分比較有統(tǒng)計(jì)學(xué)差異，青少年拇外翻患者拇外翻角、跖間角、跖楔關(guān)節(jié)活動(dòng)度均大于成年人拇外翻患者和足趾正常青少年，但AOFAS評(píng)分小于足趾正常青少年大于成年人患者。 2、跖間角大于15度青少年患者跖骨遠(yuǎn)端截骨加跖骨基底截骨術(shù)組拇外翻角、跖間角、AOFAS評(píng)分與單純遠(yuǎn)端截骨術(shù)組比較有統(tǒng)計(jì)學(xué)差異。遠(yuǎn)端截骨加跖骨基底截骨術(shù)組拇外翻角、跖間角均低于單純遠(yuǎn)端截骨術(shù)組，但AOFAS評(píng)分高于單純遠(yuǎn)端截骨術(shù)組。對(duì)于這部分患者應(yīng)行跖骨遠(yuǎn)端截骨加跖骨基底截骨矯形術(shù)。 3、跖楔關(guān)節(jié)活動(dòng)度大的青少年患者跖骨遠(yuǎn)端截骨加跖楔關(guān)節(jié)融合術(shù)組拇外翻角、跖間角，AOFAS評(píng)分與單純遠(yuǎn)端截骨術(shù)組比較有統(tǒng)計(jì)學(xué)差異，遠(yuǎn)端截骨加跖楔關(guān)節(jié)融合術(shù)組拇外翻角、跖間角，均低于單純遠(yuǎn)端截骨術(shù)組，但AOFAS評(píng)分高于單純遠(yuǎn)端截骨術(shù)組。對(duì)于這部分患者應(yīng)行跖骨遠(yuǎn)端截骨加跖楔關(guān)節(jié)融合術(shù)。
[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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R687.3

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