目的 运用前瞻性队列研究探索应用拉力螺钉和锁定钢板固定第一跖骨近端斜形截骨治疗拇外翻的临床疗效和并发症情况。方法 自2008年5月至2010年4月，所有本院第一跖间角(IMA)大于16°的拇外翻手术患者纳入本研究。患者的术前、术后评估采用美国足踝外科协会评分标准(AOFAS)评分。共有63例患者的71足纳入本研究，其中44例患者(69.84%)使用拉力螺钉固定，19例患者(30.16%)使用锁定钢板。所有患者的平均年龄为(57.5±13.7)岁。结果 两组的年龄、术前和术后的AOFAS评分均无统计学差异。螺钉组的随访AOFAS评分平均为78.9±13.6，而钢板组为73.3±19.0 (P＜0.05)，且两组的术后AOFAS评分较术前均有显著改变，差别具有统计学意义(P＜0.05)。在全部病例中，有7例患者(11.11%)拇外翻复发，其中6例(9.52%)是螺钉组，1例(1.59%)是钢板组。在7例复发的患者中，全部是大于60岁的老年人。结论 在IMA大于16°的拇外翻患者的治疗中，使用锁定钢板和拉力螺钉对第一跖骨近端斜形截骨进行固定后的临床疗效和并发症情况无明显差异，长期结果有待于进一步随访。
Objective A prospective cohort study of the proximal oblique osteotomy of first metatarsal,stabilized with either lag screws or a locking plate,was undertaken to investigate the efficiency and complications.Methods From May 2008 to April 2010,involving patients were treated for hallux valgus with IMA greater than 16.All patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score before and after surgery.The cohort included 71 procedures in 63 patients,44 (69.84%) of which were xated with lag screws and 19 (30.16%) with locking plates.The overall mean patient age was (57.5±13.7) years.Results No statistically signicant differences were found between the xation groups relative to age,preoperative and postoperative AOFAS scores.Postoperatively,the mean AOFAS score for the lag screw group was 78.9±13.6 and that for the locking plate group was 73.3±19.0 (P＜0.05).In both groups,the AOFAS scores improved signicantly (P<.005) after surgery.Overall,7(11.11%) recurrent hallux valgus deformities were observed,6 (9.52%) in the lag screw group and 1 (1.59%) in the locking plate group.All of the 7 recurrences were older than 60 years.Conclusion In the treatment of hallux valgus with IMA greater than 16,there is no significant difference in clinical efficacy and complications with proximal oblique osteotomy of the first metatarsal stabilized by lag screws and locking plate.Further follow-up is needed to get the long-term results.
[1]Chiodo CP,Schon LC,Myerson MS.Clinical results with the Ludloff osteotomy for correction of adult hallux valgus[J].Foot Ankle Int,2004,25(8):532-536.
[2] Robinson AH,Limbers JP.Modern concepts in the treatment of hallux valgus[J].J Bone Joint Surg Br,2005,87(8):1038-1045.
[3] Saxena A,McCammon D.The Ludloff osteotomy:a critical analysis[J].J Foot Ankle Surg,1997,36(2):100-105.
[4] Trnka HJ,Hofstaetter SG,Hofstaetter JG,et al.Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet[J].J Bone Joint Surg Am,2008,90(3):531-539.
[5] Robinson AH,Bhatia M,Eaton C,et al.Prospective comparative study of the scarf and Ludloff osteotomies in the treatment of hallux valgus[J].Foot Ankle Int,2009,30(10):955-963.
[6] Ludloff K.Die beseitigung des hallux valgus durch die Schrage planta-dorsale osteotomie des metatarsus 1[J].Arch Klin Chir,1918,110(3):364-387.
[7] Jung HG,Guyton GP,Parks BG,et al.Supplementary axial Kirschner wire fixation for crescentic and Ludloff proximal metatarsal osteotomies:a biomechanical study[J].Foot Ankle Int,2005,26(8):620-626.
[8] Bae SY,Schon LC.Surgical strategies:Ludloff first metatarsal osteotomy[J].Foot Ankle Int,2007,28(1):137-144.
[9] Choi WJ,Yoon HK,Yoon HS,et al.Comparison of the proximal chevron and Ludloff osteotomies for the correction of hallux valgus[J].Foot Ankle Int,2009,30(12):1154-1160.
[10] Beischer AD,Ammon P,Corniou A,et al.Three-dimensional computer analysis of the modified Ludloff osteotomy[J].Foot Ankle Int,2005,26(8):627-632.
[11] Petroutsas J,Trnka HJ.The Ludloff osteotomy for correction of hallux valgus[J].Oper Orthop Traumatol,2005,17(1):102-117.
[12] Tsilikas SP,Stamatis ED,Kourkoulis SK,et al.Mechanical comparison of two types of fixation for Ludloff oblique first metatarsal osteotomy[J].J Foot Ankle Surg,2011,50(6):699-702.
[13] Trnka HJ,Muhlbauer M,Zembsch A,et al.Basal closing wedge osteotomy for correction of hallux valgus and metatarsus primus varus:10- to 22-year follow-up[J].Foot Ankle Int,1999,20(3):171-177.
[14] Unal AM,Baran O,Uzun B,et al.Comparison of screw-fixation stabilities of first metatarsal shaft osteotomies:a biomechanical study[J].Acta Orthop Traumatol Turc,2010,44(1):70-75.
[15] Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[16] Saxena A.Return to athletic activity after foot and ankle surgery:a preliminary report on select procedures[J].J Foot Ankle Surg,2000,39(2):114-119.
[17] Kim T,Ayturk UM,Haskell A,et al.Fixation of osteoporotic distal fibula fractures:A biomechanical comparison of locking versus conventional plates[J].J Foot Ankle Surg,2007,46(1):2-6.
[18] McInnes BD,Bouche RT.Critical evaluation of the modified Lapidus procedure[J].J Foot Ankle Surg,2001,40(2):71-90.
[19] Cook JJ,Cook EA,Rosenblum BI,et al.Validation of the American College of Foot and Ankle Surgeons Scoring Scales[J].J Foot Ankle Surg,2011,50(4):420-429.
