Lapidus手术结合正骨手法治疗老年足拇外翻

目的:探讨Lapidus手术结合中医正骨手法治疗老年足拇外翻的临床疗效。方法:2013年3月至2017年10月采用Lapidus手术结合中医正骨手法治疗老年足拇外翻患者53例(87足),男12例(18足),女41例(69足);年龄65～92(76.3±4.8)岁。观察手术截骨固定时间,术前及术后26个月时采用视觉模拟评分法(VAS)进行足部疼痛缓解程度评分,并采用AOFAS评分进行功能评定,比较负重位X线片测量拇外翻角(HVA角),第1、2跖间角(IMA角),跖楔角(MCA角)变化情况。结果:53例(87足)获得随访,时间12～42(26.0±2.7)个月。所有患者第1跖楔关节于6～8个月达到骨性融合,平均4.7个月。术前VAS评分8.06±1.44,与术后26个月2.14±1.98比较,差异有统计学意义(P0.05);术前AOFAS评分53.90±7.89,与术后26个月92.80±2.78比较,差异有统计学意义(P0.05);术前HVA(38.60±2.72)°、IMA(21.90±1.91)°、MCA(20.90±2.20)°,与术后26个月的(17.80±1.94)°、(9.70±2.56)°、(11.70±0.48)°比较,差异有统计学意义(P0.05)。根据AOFAS评分,优74足,良11足,可2足。结论:Lapidus手术结合中医正骨手法治疗老年足拇外翻临床疗效满意,缩短了术中截骨固定时间,保护了截骨端周围的软组织和将骨端融合在最为满意的位置。

Lapidus operation combined with bone setting manipulation in treatment of hallux valgus in elderly patients

Objective: To investigate the clinical effect of Lapidus operation combined with bone setting manipulation of traditional Chinese medicine in treating hallux valgus in elderly patients.Methods: From March 2013 to October 2017,53 elderly patients (87 feet) with hallux valgus were treated with Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine,including 12 males (18 feet) and 41 females (69 feet),ranging in age from 65 to 92 years old,with an average of (76.3±4.8) years old. Visual analogue scale(VAS) was used to evaluate the degree of relief of foot pain before and 26 months after operation. American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate the function of foot pain. The changes of hallux valgus angle(HVA angle),interphalangeal angle (IMA angle) and metatarsal wedge angle(MCA angle) were compared on X-ray films. Result: All the patients were followed up,and the duration ranged from 12 to 42 months,with an average of(26.0±2.7) months. In all patients,the first metatarsal joint reached bone fusion within 6 to 8 months,with an average of 4.7 months. The preoperative VAS score was 8.06±1.44,which was significantly different from 2.14±1.98 at 26 months(P<0.05). The preoperative AOFAS score was 53.90±7.89,which was significantly different from 92.80±2.78 at 26 months(P<0.05). The HVA,IMA and MCA were significantly improved from preoperative(38.60±2.72)°,(21.90±1.91)ånd(20.90±2.20)° to the latest follow-up(17.80±1.94)°,(9.70±2.56)° and(11.70±0.48)°(P<0.05). According AOFAS score,74 feet got an excellent result,11 good and 2 fair.Conclusions: Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine on the treatment of hallux valgus foot in elderly patients has satisfactory clinical effects,shortens the time of osteotomy and fixation,protects the soft tissue around the osteotomy end and promotes the bone fusion on the most satisfactory position.