可吸收螺钉在踇外翻第1跖骨远端改良chevron截骨中的应用

背景：第1跖骨远端改良chevron截骨是治疗踇外翻的常用术式,应用可吸收螺钉进行固定的效果尚存争议。目的：评价可吸收钉在踇外翻第1跖骨远端改良chevron截骨中的应用效果。方法：对8例中度踇外翻患者行远端改良chevron截骨,V形截骨后采用1枚2.7mm可吸收螺钉固定,穿前足免负重鞋6～8周。结果与结论：纳入的8例患者均获随访,随访时间28～46个月。患者伤口均一期愈合,踇外翻角改善为15°～21°,平均（17.63±2.07）°;第1,2跖骨间角为7°～9°,平均（8.00±0.76）°;美国足踝外科协会踇趾-跖趾-趾间关节评分由术前的（70.13±7.10）分提高到术后的（92.75±7.30）分（P〈0.05）。说明远端改良chevron截骨后使用可吸收螺钉固定治疗轻中度踇外翻疗效可靠,是一种有效的固定方法。     

迷你双螺纹空心钉结合截骨治疗拇外翻

背景：拇外翻畸形矫正方式多样,采用迷你双螺纹空心钉材料结合截骨矫形的方式损伤小,能够满足拇外翻矫形的目的,是临床上新型的微创生物型内固定材料。目的：回顾性分析迷你双螺纹空心钉材料应用于截骨矫形拇外翻治疗中的临床疗效。方法：选择拇外翻畸形患者30例,其中双侧矫形患者8例,单侧矫形患者22例。根据自愿均采用第一跖骨截骨矫形迷你双螺纹空心钉内固定,治疗前后拍摄X射线片测量外翻角、跖间角、籽骨位置,进行AOFAS评分,并计算第一跖骨短缩长度。结果与结论：采用迷你双螺纹空心钉结合截骨矫形治疗后,拇外翻畸形患者的外翻角、跖间角、AOFAS评分及籽骨位置较治疗前明显改善,第一跖骨短缩在矫形可控范围内避免畸形复发及跖骨痛。     

第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻

目的探讨第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻的疗效。方法以江苏省人民医院2010年1月至2017年8月收治的80例拇外翻患者为对象,共131足。其中中重度拇外翻68足,对此68足拇外翻患者均予以第一跖骨基底部楔形截骨联合改良Mcbride手术治疗,分析疗效。结果随访时间均为术后1年,拇外翻角、第一与二跖骨夹角、第一跖骨远端关节面角均小于术前,差异有统计学意义(P均<0. 01);并发症发生率为3. 33%(2/68)。术后1年VAS疼痛评分(1. 68±0. 12)分,较术前的(6. 65±0. 31)分降低(P <0. 01),AOFAS评分(89. 54±2. 36)分,较术前的(42. 38±3. 42)分升高(P <0. 01)。结论第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻,可改善患者症状,且并发症少,可有效缓解患者疼痛、促进足部功能康复。     

Link动力加压钢支架治疗踇外翻

目的探讨link动力加压钢支架治疗踇外翻的效果及其适应证。方法采用改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻13例,对术后疼痛缓解程度,关节活动和外形改善进行比较。结果 13例手术优良率为100%,术后未出现并发症。结论改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻效果良好。     

Ludloff截骨修复矫治拇外翻的三维力学特点

背景：目前针对Ludloff截骨三维特点的研究甚少,且结论稍有不同,导致不能准确地理解其截骨特点。目的：分析Ludloff截骨技术修复矫治拇外翻的三维力学特点。方法：采用长86.56mm、直径30.65mm的木质圆柱体,进行Ludloff截骨矫治拇外翻的模拟试验,测量并记录数据。结果与结论：圆柱体的长度随矫形程度的增加而逐渐短缩;无论截骨面偏向跖侧、背侧或水平,截骨的结果均导致远端内旋。Ludolff截骨矫治拇外翻的结果是使截骨远端呈内旋,这对改善第一跖趾关节生物力学有积极的作用。对于有明显跖骨痛的患者可采用偏向跖侧15°～20°的截骨面;对于Ⅰ/ⅡIMA（≥30°）的患者,应谨慎使用Ludolff截骨。     

Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study

BackgroundDeformity of the first ray in hallux valgus patient has been deemed to mainly contribute to instability of the metatarsophalangeal joint. However, it is not clear whether the fixation of the distal osteotomy fragment and transposition of the sesamoid represent the best method for hallux valgus treatment. The aim of this study was to examine how postoperative hallux valgus osteotomy affects the stability of the first ray.MethodsTo accurately investigate the biomechanical behavior of the first ray in pre-/postoperative hallux valgus patients, we described the relative displacement and stress distribution of the first metatarsal bone and sesamoid by imageology, test measurement and foot finite element model.FindingsCompared with the preoperative hallux valgus, the plantar pressure decreased by 47.8% and was redistributed on second metatarsal region. The peak stress and relative displacement of the distal osteotomy fragment increased by +55.7% and −59.9%, respectively. The movement of this component shifted toward the positive sagittal axis direction. In addition, the relative displacement of sesamoid decreased by 87.4% (0.18 mm) in vertical axis direction and the stress was also redistributed on medial and lateral region. Moreover, the strain of the medial main ligament was more favorable to reconstruct function of the first ray.InterpretationThe findings showed that the osteotomy method was helpful for stability of the first ray. This would provide the stability suggestions for postoperative hallux valgus fixation and guide further rehabilitation.     

Biomechanical comparison of hallux valgus correction using the proximal chevron osteotomy fixed with a medial locking plate and the Ludloff osteotomy fixed with two screws

BackgroundFor moderate-to-severe hallux valgus deformities with a 1–2 intermetatarsal angle in excess of 15°, a proximal first metatarsal osteotomy is indicated. The ideal osteotomy has yet to be defined, but should inherently limit the incidence of dorsal malunion and allow for early ambulation. The present study evaluates the mechanical integrity of two popular first metatarsal osteotomies.MethodsTen matched pairs of fresh-frozen cadaveric first metatarsals were harvested. In one metatarsal from each pair, a Ludloff osteotomy was created and fixed with two cannulated 3.5 mm screws. In the contralateral first metatarsal, a proximal chevron osteotomy was performed and subsequently fixed with a medially applied locking plate. All specimens were mounted within an Instron 1321 servohydraulic materials testing machine and subjected to a plantar-to-dorsal cantilever bending protocol for 1000 cycles.FindingsTwo of ten Ludloff osteotomies failed prior to completion of 1000 loading cycles by fracture at the distal screw site, whereas six of ten proximal chevrons failed prior to the 1000th cycle. The mode of failure in this group was by cut-out of the plantar-proximal screw. The bending stiffness of the Ludloff osteotomy exceeded that of the proximal chevron at all measurement points between the 1st and 200th load cycles (P < 0.05). After 200 cycles, an inadequate number of plate constructs survived to allow statistical comparison.InterpretationThe results of the present study indicate that the proximal chevron osteotomy fixed with a medially based locking plate exhibits mechanical properties inferior to those of the Ludloff osteotomy under the tested conditions.     

Biomechanical consequences of first metatarsal osteotomy in treating hallux valgus

Background

Among the numerous osteotomies for correction of hallux valgus, the modified chevron is known for its good intrinsic stability and the scarf for its large corrective potential. An intermediate design, the reversed-L osteotomy, has been developed to combine these competing biomechanical objectives. The purpose of this in vitro study was to compare the structural and local biomechanical performance of these three designs.

Methods

Stiffness, cortical bone strains (a factor relevant to bone remodeling), strength and failure mode of the scarf, modified chevron and reversed-L osteotomies were measured on human specimens in two different loading configurations.

Findings

The scarf osteotomy caused significant changes in stiffness and cortical bone strains with the proximal apex being at the origin of bone failure. The chevron and reversed-L had a generally comparable response to the intact bone. The chevron specimens failed by pivoting of the distal fragment, and the reversed-L by pivoting or fracture.

Interpretation

This is the first study to investigate the cortical bone strain changes induced by these invasive osteotomies. Alterations from the intact bone response could be directly related to the design of the osteotomy. Notably, the critical weakening proximal apex of the scarf is avoided in the reversed-L, leading to results comparable to the chevron. This study provides support in favor of the intermediate design of the reversed-L as an effective compromise between the competing biomechanical objectives of corrective potential and mechanical stability.     

改良Chevron截骨术治疗拇外翻畸形

目的：探索一种治疗中轻度拇外翻效果满意的术式。方法：对15例（21足）轻中度拇外翻畸形患者施行第一跖骨远端改良Chevron截骨拇术，采用美国足踝外科协会Maryland评分标准对疗效进行评定，结果术后无不愈合或延迟愈合、无感染。Maryland拇指关节评分90～100分者16足（76％）80～89分者4足（19％）70-79分者1足（5％）结论：该截骨术传统Chevron截骨术比较具有三维调节截骨远端的能力，截骨部骨接触面积大、嵌合固定好的特点。微弧形克氏针锁扣固定牢靠、操作简单、拔钉容易。对于轻中度有症状的拇外翻畸形是一种较为理想的治疗方法．     

拇外翻术后拇外翻角和第1-2跖骨间角X射线测量方法评价

背景：拇外翻术后拇外翻角和第1-2跖骨间角的测量关键在于第1跖骨轴线的确定。第1跖骨轴线的不同确定方法,造成了这两个角度测量值的差异,使不同临床研究之间的数据不具有可比性。对于拇外翻术后角度测量,国内外尚未形成公认的标准方法。目的：回顾不同拇外翻术后拇外翻角和第1-2跖骨间角的测量方法的研究进展,为拇外翻的术后测量与评价研究提供参考。方法：由第一作者在2012年2月检索PubMed、中国期刊全文数据库以及万方数据库。其中,英文检索词为：＂hallux valgus＂、＂angles＂、＂radiographic measurements＂。中文检索词为＂拇外翻＂、＂角度＂、＂X射线测量＂。选取29篇文献进行归纳总结。结果与结论：最好的测量方法其标记点必须是易于确定,可重复性好,应尽量避免受到截骨部位及跖骨本身解剖变异的影响。拇外翻术后X射线测量方法目前多用头部中心/基底部中心测量方法。专业化的工具软件测量取代手工测量是未来拇外翻术后X射线测量的发展趋势。     

康复疗法在微创技术治疗拇外翻术后的疗效观察

目的探讨微创技术治疗拇外翻术后系统规范的康复疗法的疗效。方法选取采用微创技术治疗的100例拇外翻患者,术后实施规范的康复治疗,观察手术前后拇外翻角度HAV、第一和第二跖骨间角度M角、拇趾-跖趾-趾间关节AOFAS评分指标。结果 100例拇外翻微创小切口手术患者均手术成功,无护理并发症发生;患者术后关节功能优良率高达97.92%,术后HAV角度平均矫正20.07°,M角度平均矫正4.29°,拇趾-跖趾-趾间关节AOFAS评分较术前提高30.79分。结论将康复疗法应用于微创技术治疗拇外翻术后,可恢复关节功能,有效预防跖趾关节粘连,减少手术并发症。     

拇外翻主要病理改变及组织修复方法的选择

拇外翻其病理改变具有多样性的,包括第一跖骨内收、第一,二跖骨问角增大、拇趾外翻角增大、第一跖趾关节近端关节面固定角或远端关节面固定角增大、籽骨移位、软组织平衡的改变等.X射线测量是确定拇外翻病理改变的主要的手段.拇外翻病理改变的多样性使得修复方式具有多样性,主要有软组织修复、截骨修复和关节融合或关节成形等修复方式.拇外翻修复方式的选择应该个体化,根据患者具体的病理改变选择一个或多个修复方式.     

So-called minimal intervention in hallux valgus

A comparison between isolated removal of the pseudoexostosis (Schede) and the combined procedure of proximal transfer of the adductor tendon added to pseudoexostosis removal proved the importance of dissection of the adductor, but failed to demonstrate any advantage of the transfer and shortening of this muscle. Neither procedure improved the metatarsal angle permanently. The hallux valgus angle showed a strong tendency of recurrence after the Schede procedure. Both procedures produced a high rate of subjective satisfaction of over 90%, notwithstanding the objective results.     

Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus

[Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.Key words: Hallux valgus, Radiography, Toe-spread-out exercise     

Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus

Objective

To evaluate the correlation between the Manchester Grading Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) score in patients with a hallux valgus deformity.

Subjects and Methods

The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as the control group. The severity of hallux valgus, utilizing a relative nonmetric scale, the Manchester Grading Scale, and the metric AOFAS score, was determined for all individuals in the hallux valgus and control groups. SPSS version 18 (Chicago, Ill., USA) was used for data analysis.

Results

According to the Manchester Grading Scale, the 424 feet of the normal group were classified as ‘no deformity−. In the hallux valgus group, 85 feet were classified as ‘mild deformity−, 67 as ‘moderate deformity'' and 29 as ‘severe deformity−. The AOFAS total score in the control group was 99.14. In the hallux valgus group, patients with mild or moderate deformity had total scores of 86.20 and 68.19, respectively. For those with severe hallux valgus, the total score was 44.69 and the differences were statistically significant (p = 0.000). Using the Pearson correlation, strong negative correlations were found between the AOFAS score and the hallux valgus angle (HVA; r = −0.899, p = 0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatarsal angle (IMA) as well (r = −0.748, p = 0.000).

Conclusions

The AOFAS score was negatively associated with the Manchester Grading Scale, HVA and first IMA. As the severity of hallux valgus increased, the AOFAS score seemed to decrease.Key Words: Hallux valgus, Manchester Grading Scale, American Orthopaedic Foot and Ankle Society score     

Is low-intensity pulsed ultrasound effective for revitalizing a severely necrotic small bone? An experimental rabbit model

Previously, we successfully applied a new method composed of drilling, bone marrow transplantation (BMT), external fixation and low-intensity pulsed ultrasound (LIPUS) for the clinical treatment of Kienböck’s disease. The purpose of this study was to investigate whether bone regeneration can be induced by LIPUS and/or multiple drilling and/or BMT within a severely necrotic small-bone rabbit model. Eighteen rabbits were divided into three groups (BMT, drilling and control) and LIPUS stimulation was introduced daily for 8 weeks post-transplantation. Next, 12 additional rabbits were produced for the BMT group and LIPUS stimulation was introduced daily for 4 and 12 weeks (n = 6 for each). Histopathologically, new bone formations were rarely observed in the drilling and control groups. In the BMT group, the mineralizing surface areas of LIPUS(+) showed a significant increase compared with LIPUS(−) for 8 weeks. LIPUS treatment alone did not accelerate the revitalization of necrotic bones. However, LIPUS combined with BMT tended to promote new bone formation.     

The effects of a new foot-toe orthosis in treating painful hallux valgus

OBJECTIVE: To assess the effects of a new foot-toe orthosis on painful hallux valgus. DESIGN: Uncontrolled intervention study. SETTING: An outpatient clinic in a tertiary medical center with an orthotic laboratory in Taiwan. PARTICIPANTS: Seventeen patients with painful hallux valgus. INTERVENTION: Application of a new total contact insole with fixed toe separator. MAIN OUTCOME MEASURES: The hallux valgus angle, an 11-point numeric rating scale (NRS-11) for pain assessment, and walking ability scale. RESULTS: The average hallux valgus angle reduction +/- standard deviation was 6.5 degrees +/-3.8 degrees after insole application (P<.001). An improvement on the NRS-11 pain scale from 4.06+/-2.8 to 0.88+/-1.17 (P<.001) was noted after immediate insole application and was.42+/-.67 (P=.002) 3 months later for the 12 patients who completed the study. The walking ability scale improved at least 1 grade or more after the insole was worn for 3 months (P=.002). All patients tolerated the insole well without any clinical evidence of skin ulcers or blisters. CONCLUSION: Our new total contact insole with fixed toe separator reduced pain, and improved walking ability and the hallux valgus angle. It is an effective alternative treatment for patients with painful hallux valgus.     

Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet

BackgroundPatients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data.MethodsEleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups.FindingsDisplacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups.InterpretationWeightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments.     

Scarf联合Akin截骨治疗中重度拇外翻畸形疗效分析

目的探讨Scarf联合Akin截骨治疗中重度拇外翻畸形临床疗效及手术指证。方法 68例108足中重度拇外翻畸形行Scarf截骨＋Akin截骨治疗,术后采用AOFAS评分联合X线片观察疗效及影像学改变。结果 68例获随访6~12个月;手术切口均一期愈合,截骨处愈合时间12周,无延迟愈合或不愈合,术后无并发症发生,治疗优良率96%;术后拇外翻角度、第1、2跖骨间角及胫侧籽骨位置（（5.70±1.25）°、（6.20±0.92）°、（2.48±0.51）级）均较术前（（40.20±5.43）°、（18.00±2.00）°、（4.98±0.65）级）明显下降（P〈0.05）,AOFAS评分（（88.30±7.06）分）较术前（（50.80±6.09）分）明显升高（P〈0.05）。结论 Scarf＋Akin截骨手术可技术互补,治疗中重度拇外翻畸形效果良好。     

The study of surface electromyography used for the assessment of abductor hallucis muscle activity in patients with hallux valgus

Background: Hallux valgus is a common foot disorder. In patients with hallux valgus, the anatomy and biomechanics of foot is subject to alterations. Objective: The aim of this clinical and neurophysiological study is to compare the activity of abductor hallucis (AbdH) muscle between the group of patients with hallux valgus and control group of healthy people, with the use of surface electromyography. Methods: The study involved 44 feet with diagnosed hallux valgus (research group) and 42 feet without deformation (control group). The X-ray images, measurements of range of motion in the first metatarsophalangeal joint and in hallux interphalangeal joint, and the surface electromyography study recorded from AbdH muscle were performed. Results: Considering the amplitude of motor unit action potential, study participants with hallux valgus demonstrate significantly less activity of AbdH muscle than people without hallux valgus deformity. This activity is not dependent on the severity of valgus, age, or range of motion. Conclusions: It is speculated that the changes of the AbdH function may occur in the period before clinical appearance of hallux valgus deformity, or at the onset of distortion development. Further studies are needed for a comprehensive assessment of AbdH muscle in patients with hallux valgus.