本文選題：足拇外翻　切入點(diǎn)：第一跖骨　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:通過比較青少年足拇外翻應(yīng)用第1跖骨截骨矯形治療術(shù)后,分別應(yīng)用克氏針與接骨板兩種方法固定截骨端的效果,找出那種固定方法效果更好。方法:回顧性研究2008年1月至2014年7月期間,共收治青少年拇外翻39例(72足),其中獲得隨訪的患者共23例(40足),根據(jù)內(nèi)固定方式不同將獲得隨訪的患者分為A組、B組,A組用克氏針固定,B組用接骨板固定。每足術(shù)前及術(shù)后、末次隨訪時(shí)均拍攝足負(fù)重正側(cè)位X線片,測量HVA和1~2IMA;根據(jù)AOFAS足拇趾、跖趾關(guān)節(jié)、趾間關(guān)節(jié)評分進(jìn)行功能評估,并記錄并發(fā)癥發(fā)生情況。比較術(shù)前及術(shù)后、末次隨訪時(shí)拇外翻角(HVA)和1~2跖骨間角(IMA)及AOFAS評分評估患者功能愈后,選擇SPSS 19.0進(jìn)行數(shù)據(jù)統(tǒng)計(jì),數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差(c±s)來表示,均數(shù)的比較采用t檢驗(yàn),當(dāng)P0.05時(shí),差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:這兩組患者中男性5例(8足),女性18例(32足);平均年齡17.3±3.4歲(11~24歲)。平均隨訪15.6個(gè)月(12~20個(gè)月),無感染和不愈合發(fā)生,有2例3足(7.5%)出現(xiàn)負(fù)重行走時(shí)第一跖趾關(guān)節(jié)下輕度疼痛,4例7足(17.5%)出現(xiàn)足拇外翻復(fù)發(fā)。A組:HVA由術(shù)前平均35.1°±2.7°減小至術(shù)后1天平均16.5°±1.6°(P0.01)、術(shù)后1年平均22.1°±3.0o(P0.01);1~2跖骨間角IMA由術(shù)前平均15.8°±2.5°減小至術(shù)后1天平均8.7°±0.7°(P0.01)、術(shù)后1年平均10.7°±0.7 o(P0.01);AOFAS評分由術(shù)前平均39.9±8.3分提高至術(shù)后1年平均87.3±4.7分(P0.01)。B組:HVA由術(shù)前平均35.6°±3.0°減小至術(shù)后1天平均16.6°±1.2°(P0.01)、術(shù)后1年平均18.7°±2.0o(P0.01);1~2跖骨間角IMA由術(shù)前平均15.7°±2.5°減小至術(shù)后1天平均8.9°±0.7°(P0.01)、術(shù)后1年平均9.8°±0.7o(P0.01);AOFAS評分由術(shù)前平均40.5±8.1分提高至術(shù)后1年平均94.0±4.3分(P0.01)。統(tǒng)計(jì)分析表明:克氏針組與接骨板組術(shù)前HVA(P=0.565)、IMA(P=0.911)、AOFAS評分無明顯差異(P=0.818),術(shù)后1天二者HVA(P=0.737)、IMA(P=0.453)無明顯差異,術(shù)后1年,克氏針組與接骨板組HVA(P0.05)、IMA(P0.05)、AOFAS評分(P0.05)均有差異。功能評級:A組優(yōu)6足,良11足,差3足,優(yōu)良率為85.5%;B組優(yōu)12足,良7足,差1足,優(yōu)良率為95%。結(jié)論:1青少年拇外翻患者行第一跖骨截骨矯形內(nèi)固定術(shù),手術(shù)療效明顯,能夠明顯的改善癥狀。2應(yīng)用克氏針內(nèi)固定和應(yīng)用接骨板內(nèi)固定的兩組患者,在術(shù)后短期內(nèi)效果無明顯差異,術(shù)后1年差異明顯,第1跖骨截骨端應(yīng)用接骨板內(nèi)固定效果要優(yōu)于應(yīng)用克氏針內(nèi)固定。3無論克氏針內(nèi)固定組還是接骨板內(nèi)固定組,均有患者術(shù)后拇外翻復(fù)發(fā),這說明青少年拇外翻術(shù)后易復(fù)發(fā)是其特點(diǎn)。
[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 鹵standard deviation (c 鹵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 鹵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 擄鹵2.7 擄before operation to 16.5 擄鹵1.6 擄P0.01a on the first day after operation, and 1 year after operation, the average intermetatarsal angle IMA was 22.1 擄鹵3.0oP 0.01a. The average AOFAS score in group B increased from 39.9 鹵8.3 to 87.3 鹵4.7 before operation to an average of 35.6 鹵3.0 擄before operation to an average of 16.6 鹵1.2 擄P0.01a at one day after operation, and an average of 18.7 擄鹵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 擄鹵2.5 擄before operation to an average of 8.7 擄鹵0.7 擄P0.01a on 1 day after operation. The average AOFAS score increased from 39.9 鹵8.3 points before operation to 87.3 鹵4.7 minutes before operation to an average of 16.6 擄鹵1.2 擄P0.01a post operation one year after operation. The mean interangle IMA decreased from 15.7 擄鹵2.5 擄before operation to 8.9 擄鹵0.7 擄P0.01a on the first day after operation, and increased from 40.5 鹵8.1 preoperatively to 94.0 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 陳曉欣，，趙鐘岳，呂厚山;坶外翻人群抽祥調(diào)查[J];中華骨科雜志;1994年12期

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