Xu W B, Zhang F, He P P, Zhu Y Z, Yao L F, Shen C C, Wang H Q, Ren H Y, Huang L
Department of Foot and Ankle Surgery, Ningbo NO.6 Hospital, Ningbo 315040, China.
Zhonghua Yi Xue Za Zhi. 2020 Jul 21;100(27):2144-2149. doi: 10.3760/cma.j.cn112137-20200211-00242.
To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus. Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. The average age was (56±6) years. Seventeen cases (18 feet) underwent distal oblique osteotomy of the first metatarsal, 12 cases (15 feet) underwent the Youngswick osteotomy. The overall clinical evaluations were investigated before the operation and at the final follow-up, included the visual analogue scale (VAS) of the pain, American Orthopedic Foot & Ankle Society (AOFAS) scores, the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space. The data before and after operation were compared by paired test and non-parametric rank sum test. The operation time were (1.1±0.2) hours and (1.3±0.1) hours, and the intraoperative bleeding was 35 (25, 36) ml and 35 (30, 40) ml in the distal oblique osteotomy and Youngswick osteotomy respectively. All patients were followed up for 12 to 46 months. No nonunion or delayed union occurred in all patients. All patients did not need to be operated again, and no complications such as transferring metatarsalgia, infection and osteonecrosis occurred. In the two groups, the pain VAS score decreased significantly (-3.8, -3.5, both 0.01), the first metatarsophalangeal joint dorsal extension activity increased (-3.7, -3.4, both 0.01), the AOFAS score increased (28.0, 15.4, both 0.05) and the first metatarsophalangeal joint space also improved significantly (17.7, 14.6, 0.05) after the operation. There was no significant difference in VAS score, the first metatarsophalangeal joint activity and Horton index between the two groups(-1.3, -0.3, -0.4, all 0.05), and there was no statistical difference inAOFAS score (0.1, 0.05). But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, 2.2, 0.04). The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.
探讨远端斜行截骨术与扬斯威克截骨术治疗Ⅲ、Ⅳ期僵硬性拇趾的临床疗效。回顾性分析2013年5月至2018年12月在宁波市第六医院接受第一跖骨远端截骨术的29例（33足）Ⅲ、Ⅳ期僵硬性拇趾患者。其中，男性10例，女性19例。平均年龄（56±6）岁。17例（18足）行第一跖骨远端斜行截骨术，12例（15足）行扬斯威克截骨术。在术前和末次随访时进行总体临床评估，包括疼痛视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）评分、第一跖趾关节活动范围和第一跖趾关节间隙。采用配对t检验和非参数秩和检验比较手术前后的数据。远端斜行截骨术和扬斯威克截骨术的手术时间分别为（1.1±0.2）小时和（1.3±0.1）小时，术中出血量分别为35（25，36）ml和35（30，40）ml。所有患者均随访12至46个月。所有患者均未发生骨不连或延迟愈合。所有患者均无需再次手术，未发生转移性跖痛、感染和骨坏死等并发症。两组患者术后疼痛VAS评分均显著降低（分别为-3.8、-3.5，P均＜0.01），第一跖趾关节背伸活动增加（分别为-3.7、-3.4，P均＜0.01），AOFAS评分增加（分别为28.0、15.4，P均＜0.05），第一跖趾关节间隙也显著改善（分别为17.7、14.6，P＜0.05）。两组患者的VAS评分、第一跖趾关节活动度和霍顿指数比较差异无统计学意义（分别为-1.3、-0.3、-0.4，P均＞0.05），AOFAS评分比较差异无统计学意义（P = 0.1，P＞0.05）。但与第一跖骨远端斜行截骨术相比，扬斯威克截骨术后关节间隙更大（（2.4±0.3）mm对（2.1±0.4）mm，P = 2.2，P＜0.04）。跖骨斜行截骨术和扬斯威克截骨术可有效缓解僵硬性拇趾疼痛，增加第一跖趾关节背伸活动度和关节间隙，降低第一跖骨头高度，改善患者生活状况。跖骨远端截骨术和扬斯威克截骨术治疗Ⅲ、Ⅳ期僵硬性拇趾的效果相似，均可延缓病情进展。
