拇外翻微创术跖骨远端位移内侧纵弓顶角与胼胝痛的关系

目的通过X线的二维测定探讨中西医结合微创技术治疗拇外翻,跖骨远端位移(跖屈或跖移)、足内侧纵弓顶角与胼胝痛(VAS)三者之间的关系。方法自2006年7月～2007年6月,笔者于手术治疗拇外翻(均采用同一术式:中西医结合微创技术)42例79足。手术前后摄负重正侧位X线片,测量内侧纵弓顶角;并进行症状体征检查,记录胼胝及胼胝痛(VAS)。根据VAS量表将研究对象分为疼痛加重组、疼痛减轻组。各组研究对象又根据远端跖骨块的位置改变情况分为两组:跖屈或跖移(向背侧成角)组;非跖屈或跖移组。比较各组间内侧纵弓顶角差的差异。平均随访时间6.5个月。结果胼胝及胼胝痛术后加重5足,其余均减轻。术后胼胝及胼胝痛的变化与术后远端跖骨块位置情况比较,P<0.05;术后胼胝及胼胝痛的变化与手术前后内侧纵弓顶角差比较,P<0.05;术后远端跖骨块位置情况与手术前后内侧纵弓顶角差比较,P<0.05。差异均有显著性。结论通过截骨远端跖骨块足够的跖移、跖屈可以减小足内侧纵弓顶角,弥补因短缩引起的内侧纵弓高度的丢失,减少术后胼胝疼痛等并发症发生的概率。

Relationship Among Callositas, Metatarsalgia, Apex Angle of Indulging Arcus and Plantar Flexion (Shifting) of Distal End of Metatarsal Bone Block After Minimal Incision Treatment for Hallux Valgus

Objective To investigate the relationship among callositas,metatarsalgia and apex angle of indulging arcus after minimal incision treatment for hallux valgus by X-ray.Methods Twenty-nine feet of 42 patients with hallux valgus between July 2006 and June 2007 were included.At the time of follow-up,with a mean of 6.5 months after operation,all patients were evaluated clinically and radiographically by measuring the apex angle of indulging arcus and recording callositas and metatarsalgia(VAS).According to VAS,all patients were classified into 2 groups:pain-sharpening group,pain-lightening group.According to position of distal end of metatarsal bone block,every group was further classified into 2 subgroups:plantar flexion(shifting) and non-plantar flexion(shifting).The difference of apex angle of indulging arcus of inter-groups perioperatively was compared.Results The result of comparison between VAS and perioperative apex angle of indulging arcus was P<0.05;The result of comparison between position of distal end of metatarsal bone block and perioperative apex angle of indulging arcus was P<0.05;The result of comparison between VAS and position of distal end of metatarsal bone block was P<0.05.The procedure significantly reduced pain.Conclusion The callositas and metatarsalgia(VAS) is closely related to apex angle of indulging arcus and plantar flexion(shifting) of distal end of metatarsal bone block.