微創(chuàng)跖骨頭頸截骨抬高術(shù)治療無脫位型跖痛癥臨床療效初探
發(fā)布時間：2019-02-21 17:54
【摘要】：1目的探討微創(chuàng)跖骨頭頸截骨抬高術(shù)治療無脫位型跖痛癥的臨床療效。2方法從2013年6月至2015年3月,于中國中醫(yī)科學(xué)院望京醫(yī)院骨關(guān)節(jié)二科接受微創(chuàng)跖骨頭頸截骨抬高術(shù)治療無脫位型跖痛癥患者,經(jīng)長期隨訪資料完整者24例26足,共55個跖骨,左足17,右足9(納入28例32足,脫落4例6足,脫落病例均為失訪所致)其中男3例3足,女21例23足；年齡47歲一78歲,平均56.3歲。采用微創(chuàng)跖骨頭頸截骨抬高術(shù)治療,第二跖骨21個、第三跖骨21個、第四跖骨13個,隨訪時間6月-18月,平均13月。受試者均于手術(shù)前及手術(shù)后3個月、6個月、12個月的時間內(nèi)測量記錄責(zé)任趾跖趾關(guān)節(jié)活動度、視覺模擬量表(VAS)評分、責(zé)任跖骨頭下的壓痛指數(shù),采用美國足踝醫(yī)師學(xué)會前足評分系統(tǒng)(ACFAS)對受試者進行評估,同時使用Footscan足底壓力分析儀測量并且記錄正常行走步態(tài)周期中相應(yīng)跖骨頭下所承受最大壓力、最大壓強及沖量的前后變化,并且拍攝患者足部X線片包括負(fù)重與非負(fù)重位片,并對其中的指標(biāo)進行臨床研究,術(shù)前告訴患者詳情,簽署知情同意書,符合病例納入條件,無手術(shù)禁忌癥的患者納入本研究中。為確立病例納入質(zhì)量,由三名副高職稱及以上從事足踝外科的專家評定病例的納入,采取簡單多數(shù)原則,對于有爭議的進行三方協(xié)商確定,最后符合x線分度為0-1度的病例納入本研究。3結(jié)果微創(chuàng)跖骨頭頸截骨抬高術(shù)治療無脫位型跖痛癥VAS評分術(shù)前為(4.23±0.96)分,術(shù)后為(1.55±1.05)分,ACFAS評分術(shù)前為(56.47±8.16)分,術(shù)后為(84.51±4.39)分,壓痛指數(shù)術(shù)前為(2.09±0.67)分,術(shù)后為(0.38±0.49)差異均有統(tǒng)計學(xué)意義(P0.05)；責(zé)任跖趾關(guān)節(jié)活動度術(shù)前為(57.42±8.41)度,術(shù)后為(31.07±6.34)責(zé)任跖骨頭下最大壓力術(shù)前為(136.25±19.42)N,術(shù)后為(75.13±13.87)N,最大壓強術(shù)前為(15.15±2.34)cm2,術(shù)后為(9.25±2.63)cm2,沖量術(shù)前為(49.70±12.09)Ns,術(shù)后為(23.95±6.59)Ns,差異均有統(tǒng)計學(xué)意義(P0.05)。術(shù)后轉(zhuǎn)移性跖骨頭下疼痛2例,占3.63%,術(shù)后跖骨無骨折不愈合；截骨端延遲愈合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,囑其減少負(fù)重,口服補腎壯骨中藥顆粒劑后均于術(shù)后7-11個月內(nèi)愈合。術(shù)后足跖皮膚麻木3足,占11.53%,未經(jīng)特殊處理,于術(shù)后3-5個月內(nèi)恢復(fù)正常皮膚感覺。本組研究中未出現(xiàn)足趾切口皮膚壞死、足部軟組織感染、胼胝體復(fù)發(fā)、深靜脈血栓等其他并發(fā)癥。4結(jié)論基于跖痛癥X線分度標(biāo)準(zhǔn)確定的微創(chuàng)跖骨頭頸截骨抬高術(shù)治療無脫位型跖痛癥(X線分度0-1度),可明顯改善跖骨頭下疼痛癥狀,對于臨床治療有指導(dǎo)意義。
[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 鹵0.96) before operation and (1.55 鹵1.05) after operation. ACFAS score was (56.47 鹵8.16) points before operation, (84.51 鹵4.39) points after operation, (2.09 鹵0.67) points before operation and (0.38 鹵0.49) points after operation (P0.05). The range of motion of the metatarsophalangeal joint was (57.42 鹵8.41) before operation, (31.07 鹵6.34) before operation and (136.25 鹵19.42) N under the head of the responsible metatarsal, and (75.13 鹵13.87) N after operation. The maximum pressure was (15.15 鹵2.34) cm2, and (9.25 鹵2.63) cm2, impulse before and after (49.70 鹵12.09) Ns, and (23.95 鹵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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：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 鹵0.96) before operation and (1.55 鹵1.05) after operation. ACFAS score was (56.47 鹵8.16) points before operation, (84.51 鹵4.39) points after operation, (2.09 鹵0.67) points before operation and (0.38 鹵0.49) points after operation (P0.05). The range of motion of the metatarsophalangeal joint was (57.42 鹵8.41) before operation, (31.07 鹵6.34) before operation and (136.25 鹵19.42) N under the head of the responsible metatarsal, and (75.13 鹵13.87) N after operation. The maximum pressure was (15.15 鹵2.34) cm2, and (9.25 鹵2.63) cm2, impulse before and after (49.70 鹵12.09) Ns, and (23.95 鹵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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
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