改良McBride手术联合跖骨双截骨术治疗青少年踇外翻的生物力学分析

目的?对改良McBride手术联合跖骨双截骨术治疗青少年踇外翻的生物力学进行分析。方法?选取2015年4月—2018年8月在海警总队医院治疗的青少年踇外翻患者45例，按随机数字表法分为对照组（22例）和实验组（23例），分别采用改良McBride手术和改良McBride手术联合跖骨双截骨术治疗。术前和术后随访1年行足部X射线检查，测量外翻角（IMA），第1、2跖骨间角（HVA）和第4、5跖骨间角（IM 4-5），采用AOFAS功能评分评估前足功能，采用视觉模拟评分（VAS）评估疼痛。采用足底压力测试系统测量患者足底压力分布。结果?①术后随访1年，实验组患者HVA、IMA、IM 4-5和VAS评分均低于对照组，AOFAS评分高于对照组（P?<0.05）。②术后随访1年，实验组患者双足第1跖骨平均压力峰值低于对照组（P?<0.05）；而其他区域的平均压力峰值比较，差异无统计学意义（P?>0.05）。③术后随访1年，实验组患者双足第2～5趾骨、第1跖骨、足跟内侧和足跟外侧的平均冲量值低于对照组（P?<0.05）；而其他区域的平均冲量值比较，差异无统计学意义（P?>0.05）。结论?改良McBride手术联合跖骨双截骨术可能通过降低第1跖骨区压力和负重，改善踇外翻畸形，具有良好的临床应用前景。

A biomechanical analysis of modified McBride procedure combined with double metatarsal osteotomy to treat hallux valgus in adolescents

Objective To analyze the biomechanics of modified McBride procedure combined with double metatarsal osteotomy to treat hallux valgus in adolescents. Methods Forty-five juvenile hallux valgus patients admitted to our hospital from April 2015 to August 2018 were randomly divided into control group (22 cases) and research group (23 cases). The control group was treated with modified McBride procedure, while the research group was treated with modified McBride procedure combined with double metatarsal osteotomy. The podiatry X-ray was taken to measure the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA) and the fourth-fifth intermetatarsal angle (IM 4-5) before and one year after the operation. The forefoot function was evaluated by American Orthopedic Foot and Ankle Society Score (AOFAS), and the pain was assessed by visual analogue score (VAS). The plantar pressure distribution was measured by plantar pressure measurement system. Results After 1 year of follow-up, the HVA, IMA, IM 4-5 and VAS of the research group were lower than those of the control group, and AOFAS of the research group was higher than that of the control group (P??0.05). Besides, the average impulses of the second to fifth phalanges, first metatarsal bone, medial heel and lateral heel in the research group were significantly lower than those in the control group (P??0.05). Conclusions The modified McBride procedure combined with double metatarsal osteotomy may improve hallux valgus deformity by reducing the pressure and load of the first metatarsal region, which exhibits good prospects for clinical application.