不同入路外侧软组织松解在外翻Scarf截骨术中应用效果的研究

目的 探讨Scarf截骨术联合两种不同入路外侧软组织松解术治疗中、重度外翻的临床效果。方法 选取2018年1月至2019年6月中、重度外翻患者30例，随机分为2组，每组15例。A组接受Scarf截骨术，并于同一切口行外侧软组织松解术；B组接受Scarf截骨术，并于第一、二跖趾关节间另行切口行外侧软组织松解手术。比较两组术前，术后6个月的外翻角（HVA），第一、二跖骨间角（IMA），AOFAS前足评分及并发症。结果 A、B两组间比较，术前HVA、IMA、AOFAS前足评分差异无统计学意义（P>0.05）。与术前相比，两组患者手术后6个月HVA、IMA、AOFAS前足评分均得到显著改善（P<0.05），两种手术方法均能有效矫正外翻。两组间比较HVA，IMA，AOFAS前足评分手术前后的变化值差异无统计学意义（P>0.05）。A组发生1例畸形复发，2例足趾轻度麻木的并发症；B组没有出现畸形复发，但出现3例足趾轻度麻木，3例对疤痕不满意的并发症。两组均未出现感染，跖骨头缺血坏死（AVN）的并发症。结论 Scarf截骨术联合两种不同入路外侧软组织松解术均可以有效地治疗中、重度外翻。单一切口手术的患者对手术瘢痕的满意度更高。

Study on the effect of lateral soft tissue release through two different approaches in Scarf osteotomy for hallux valgus

Objective To investigate the clinical effect of Scarf osteotomy combined with two different approaches of lateral soft tissue release in the treatment of moderate and severe hallux valgus. Methods From January 2018 to June 2019, 30 patients with moderate to severe hallux valgus were randomly divided into two groups, 15 in each group. Group A underwent Scarf osteotomy and lateral soft tissue release at the same incision; group B received Scarf osteotomy and lateral soft tissue release at another incision between the first and second metatarsophalangeal joints. The hallux valgus angle (HVA), the first and second metatarsal angle (IMA), AOFAS scores and complications were compared between the two groups. Results There were no significant differences in HVA, IMA and AOFAS between the two groups before surgery (P>0.05). HVA, IMA and AOFAS were significantly improved after surgery compared with those before surgery (P<0.05), and both methods effectively corrected hallux valgus. However, there was no significant difference in the improvement of HVA, IMA and AOFAS between the two groups (P>0.05). In group A, there was 1 case with deformity recurrence, 2 cases with mild numbness of the toes. In group B, there was no deformity recurrence, but 3 cases with mild numbness of the toes, and 3 cases unsatisfied with scars. There was no infection and avascular necrosis of metatarsal head (AVN) in the two groups. Conclusion Scarf osteotomy combined with two different approaches of lateral soft tissue release can effectively treat moderate and severe hallux valgus. The patients with single incision are more satisfied with scar.