微创截骨手法整复术治疗拇外翻

目的： 探讨微创截骨手法整复术治疗拇外翻的临床疗效。方法： 自2018年1月至2019年5月采用微创截骨手法整复术治疗拇外翻患者31例（42足），其中男3例，女28例；年龄18~76（50.1±4.9）岁。观察并比较手术前后拇外翻角（hallux valgus angle，HVA），第1，2跖骨间角（inter metatarsal angle，IMA），第1，2跖骨长度差变化，术后采用美国矫形骨科学会足踝外科学组（American Orthopaedic Foot and Ankle Society，AOFAS）拇趾-跖趾-趾间关节评分系统进行功能评价。结果： 31例（42足）患者获得随访，时间14~18（15.1±1.2）个月。HVA、IM分别由术前的（38.5±5.4）°、（13.0±1.1）°矫正到术后的（14.3±4.7）°、（9.1±1.5）°（P<0.05）。术前1、2跖骨长度差为2~-4（-0.59±1.80） mm，术后为0~-6（-3.53±1.60） mm，平均第1跖骨短缩2.94 mm，差异有统计学意义（P<0.05）。AOFAS评分由术前的（57.8±9.7）分提高到术后的（92.1±9.3）分，手术前后比较差异有统计学意义（P<0.05）；其中优23足，良16足，可3足。结论： 微创截骨手法整复术手术时间短、切口小、能够有效纠正拇外翻畸形、改善前足功能，获得良好疗效。

Minimally invasive osteotomy and manual reduction for hallux valgus

Objective: To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus.Methods: From January 2018 to May 2019, 31 patients(42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of(50.1±4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society(AOFAS)score were observed and measured.Results: Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1±1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0±1.1)°, and improved to (14.3±4.7)ånd (9.1±1.5)åfter operation respectively(P<0.05). Preopertaive length difference between 1 and 2 metatarsals was 2-4(-0.59±1.80) mm, and 0 to -6(-3.53±1.60) mm after operation, the average shortening of the first metatarsal was 2.94 mm. There were significant difference between preoperative and postoperative. Preoperative AOFAS score was 57.8±9.7, increased to 92.1±9.3 at the final follow-up, there was significant differences(P<0.05). According to standard of AOFAS score, 32 feet obtain excellent results, 16 good and 3 moderate.Conclusion: Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.