摘要
Abstract
Objective To compare the clinical effect of different articular surface preparation techniques in the treatment of hallux valgus with the Lapidus procedure.Methods The clinical data of 33 patients with hallux valgus treated with the Lapidus procedure at the Northern Theatre General Hospital from January 2009 to January 2019 were analysed.They were all fixed with a plate and divided into group A(18 cases,articular wedge resection)and group B(15 cases,articular cartilage surface resection)according to the articular surface preparation techniques.Incision complications(infection,dehiscence or necrosis),bone healing time,hallux valgus angle(HVA),1st and 2nd intermetatarsal angle(IMA),first metatarsal length changes and postoperative complications were compared between the two groups.Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society(AOFAS)forefoot scale.Results Both groups completed the postoperative follow-up,with a follow-up time of 12-36 months,an average of(22.9±9.2)months.There were 1 case of incision margin necrosis and 2 cases of postoperative complications(metatarsalgia)occurred in group A,1 case of incision dehiscence and 1 case of plate irritation occurred in group B,no significant difference of postoperative complication was noticed between the two groups(P>0.05).Primary bone union was achieved in all patients.In group A,all patients achieved bone healing at 12 weeks.While in group B,14 patients achieved bone healing at 12 weeks,1 patient achieved delayed bone healing at 14 weeks.In group A,HVA and IMA were reduced from(36.1±10.2)° and(16.9±5.3)° preoperatively to(17.2±5.9)° and(5.6±1.4)° at one year after the surgery.In group B,HVA and IMA were reduced from(37.2±11.4)° and(17.3±7.7)° preoperatively to(16.2±7.4)° and(6.9±2.2)° at one year after the surgery.There were no significant differences in HVA and IMA at one year after surgery between the two groups(P>0.05).The mean amount of first metatarsal length shortening was(6.8±2.3)mm in group A and(2.6±1.1)mm in group B,the difference was statistically significant(P<0.05).There was no significant difference in AOFAS score at one year after the surgery between the two groups(P>0.05).Conclusion In patients with hallux valgus treated with the Lapidus procedure,both articular surface preparation techniques can achieve a good bone healing rate and satisfactory clinical results.Compared with traditional articular wedge-shaped resection,simple removal of the articular cartilage surface can effectively preserve the length of the first metatarsal.关键词
拇外翻/Lapidus手术/跖楔关节/关节融合术Key words
Hallux valgus/Lapidus procedure/Tarsometatarsal joint/Arthrodesis分类
临床医学
