拇外翻畸形两种拇收肌腱止点重建方法的比较

目的   比较两种拇内收肌腱止点重建方法的疗效。方法   回顾分析改良McBride手术矫正轻、中度拇外翻27例36足,拇内收肌腱缝合于第一跖骨头外侧关节囊组(A组)14例19足,经骨孔缝合于内侧关节囊组(B组)13例17足。结果   A组：拇外翻角、第1、2跖骨间夹角分别改善(14.9±3.7)°、(4.2±1.2)°,第一跖趾关节功能评分提高45±5;B组：拇外翻角、第1、2跖骨间夹角分别改善(18.1±4.3)°、(6.4±2.6)°,第一跖趾关节功能评分提高48±6。两组比较拇外翻角、第1、2跖骨间夹角差异有统计学意义（P＜0.05）;第一跖趾关节功能评分差异无统计学意义（P＞0.05）。结论   两种方法重建拇内收肌腱止点治疗轻中度拇外翻畸形临床疗效相近,但是经骨孔与内侧关节囊缝合法矫正拇外翻角、第1、2跖骨间夹角优于外侧关节囊缝合法。     

162例(302足)外翻患者趾跖籽关节炎X线分析

目的:观察外翻患者跖籽关节炎的存在以及跖籽关节炎X线表现特点。方法:通过观察162例(302足)外翻患者跖籽关节X线以及临床表现,由3位副高以上职称的骨科医生独立观察分析,根据制定的跖籽关节炎诊断标准,确定外翻患者跖籽关节炎的存在与否以及表现特点,最后进行汇总。结果:162例外翻患者302足的跖籽关节X线中广泛存在着骨关节炎的放射学表现,其中关节变形及半脱位268足,非对称性关节间隙狭窄254足,软骨下骨硬化231足,囊性变129足,关节边缘骨质增生和骨赘形成199足,关节内游离体0足。按照Kellgren & Lawrence分级:0级20足,Ⅰ级52足,Ⅱ级53足,Ⅲ级137足,Ⅳ级40足;符合跖籽关节炎诊断标准的为256足。结论:外翻畸形可产生跖籽关节炎。     

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

PurposeThe aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values.ResultsCompared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001).ConclusionThe point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.