针刀配合中医正骨手法治疗拇外翻的临床效果

目的 探讨针刀配合中医正骨手法治疗拇外翻的临床疗效及对患者步态变化的影响。方法:选取2020年8月—2021年4月收治的60例符合病例选择标准的拇外翻患者，随机分为观察组和对照组各30例。其中对照组给予微创手术截骨治疗，观察组进行针刀配合中医正骨手法进行治疗。对比两组治疗前后美国足踝外科协会(AOFAS)评分、拇外翻角(HVA)及临床疗效，采用步态分析中时空参数(步长、步速、步频及步宽)评估患者步态变化。结果:两组术后3个月、1年AOFAS中功能、疼痛、对线评分均高于术前，差异有统计学意义(P＜0.05)，术后1年各项评分均高于术后3个月，差异有统计学意义(P＜0.05)，观察组术后3个月、1年各项评分均高于对照组，差异有统计学意义(P＜0.05)；两组术后3个月、1年的HVA均较术前降低，差异有统计学意义(P＜0.05)，术后3个月与术后1年比较无差异(P＞0.05)，但观察组术后3个月、1年的HVA均更低，差异有统计学意义(P＜0.05)；术后3个月，观察组优良率高于对照组，差异有统计学意义(P＜0.05)；两组术后3个月、1年的步长、步速、步频均大于术前，且观察组术后3个月、1年均高于对照组，差异有统计学意义(P＜0.05)；步宽均小于术前，差异有统计学意义(P＜0.05)，且观察组术后3个月、1年均小于对照组，差异有统计学意义(P＜0.05)。结论:针刀配合中医正骨手法治疗拇外翻能改善拇外翻畸形症状，改善患者步态，疗效显著。

Clinical observation on treatment of hallux valgus by needle-knife combined with traditional Chinese medicine bone-setting technique

Objective　To explore the curative effect of needle knife combined with traditional Chinese medicine bone setting manipulation in the treatment of hallux valgus and its influence on the gait changes of patients.　Methods　A total of 60 patients with bunion valgus who met the selection criteria from August 2020 to April 2021 were randomly divided into observation group and control group, with 30 cases in each group. The control group was treated with minimally invasive osteotomy, but the observation group was treated with needle knife combined with traditional Chinese medicine bone setting manipulation. The American Association of foot and ankle surgeons (AOFAS) scores and hallux valgus angle (HVA) before and after treatment and clinical efficacy of the two groups were compared. The gait changes of patients were evaluated by spatio-temporal parameters (step length, pace, frequency and width) in gait analysis.　Results　AOFAS scores at 3 months and 1 year after surgery were higher than those before surgery (P < 0.05), scores at 1 year after surgery were higher than those at 3 months after surgery (P < 0.05), scores in the observation group were higher than those in the control group at 3 months and 1 year after surgery (P < 0.05). HVA at 3 months and 1 year after surgery in both groups was lower than that before surgery (P < 0.05), and there was no difference between 3 months and 1 year after surgery (P > 0.05), but HVA at 3 months and 1 year after surgery in the observation group was lower (P < 0.05). Three months after operation, the excellent and good rate of observation group was higher than that of control group (P < 0.05). The step length, step speed and step frequency of the two groups at 3 months and 1 year after surgery were higher than those before surgery, and those in the observation group were higher at 3 months and 1 year after surgery (P < 0.05). The step width was smaller than that before surgery (P < 0.05), and the observation group was smaller at 3 months and 1 year after surgery (P < 0.05).　Conclusion　The treatment of hallux valgus with needle knife combined with bone setting manipulation of traditional Chinese medicine can improve the symptoms of hallux valgus deformity and improve the gait of patients, and the curative effect is significant, which is worth popularizing.