摘要
Abstract
Objective :To compare clinical effects of the amputation of the adductor pollicis between medial approach and traditional approach in treating pollex valgus.Methods: From Jun.2008 to Mar.2009,29 patients (43 feet) with hallux valgus were retrospective analyzed.The amputation of the adductor pollicis and the lateral articular capsule were done through medial approach in 16 cases (23 feet,observed group), and distal metatarsus were commonly cut,combined with inverted releasing mauipulation during the operation and constant varus fixation and passive varus rehabilitation post-operation,including 1 male with 1 foot and 15 female with 22 feet,with an average age of (57.63±l7.96)years.The control group consist of 13 cases with 20 feet.All cases were female with an average age of (56.08±13.14)years.The patients of the control group were treated with the amputation of the adductor pollicis through traditional approach ,and the distal metatarsus were commonly cut.The length of surgical incision, HAA of pre-operation and post-operation, and VAS of post-operation were compared between two groups.Meanwhile, the pull numerical values were measured while pulling toe to HA A =0°, during operation (after the osteotomy ), at the 12th week and 1st year after operation for comparing both groups' releasing and re-conglutination situation.Results:All patients were followed up for 6 to 15 months with an average of 12 months.The total length of surgical incision in observed group were smaller less than that of control group [(3.00±0.22) cm vs (5.13±0.60) cm;t=10.59,P＜0.001].The HAA of two groups were remarkably reduced.The HAA in observed group reduced from pre-operatively (34.00±7.34)° to post-operatively (15.26±7.54)°,which had the statistical difference (t=8.54,P＜0.001) ;and the HAA in control group were reduced from preoperatively (38.00±7.98) to post-operatively (15.50±7.19), which also had the statistical difference (t=9.41, P＜0.001 ).The postoperatively HAA between two groups had no statistical difference (t=0.11,P＞0.05 ).The pains of all patients were gradually relieved after operation.From the 2nd day to 12th week after operation,the average VAS of observed group was reduced from 8.00±1.10 to 0.04±0.15,while the control group was reduced from 5.00±0.56 to 0.03±0.11.There was statistical difference in VAS within the 2nd week after operation (P＜0.001 ,P＜0.05 ) ;beyond 2nd week after operation ,there was no statistical differenee between two groups(P＞0.05 ).The pull numerical values while pulling toe to HAA=O° during operation (after the osteotomy), 12th week and 1 st year after operation in observed group were respectively (14.87±0.84), ( 15.26±0.92 ), ( 17.08±0.53 )N; while the conrail groups were respectively ( 14.85±0.93 ), (15.45±1.10), ( 17.19±0.45 ) N.There was no statistical difference between two groups(P＞O.05 ).It means that the releasing and re-conglutination situation of two groups were no remarkable difference.Conclusion:The clinical effect of medial approach to dissect the adductor muscle of the great toe is corresponded to traditional approach.Meanwhile, it reduced the amount and total length of surgical incisions, and had no appeared the complications of uncompleted release or eonglutination.It was a convenient and effective method for pollex valgus.关键词
外科手术,微创性/(足母)外翻/病例对照研究
