中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (26): 4234-4239.doi: 10.3969/j.issn.2095-4344.2017.26.023

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    下一篇

拇外翻术后应用超趾石膏托与前足减压鞋维持矫形效果的对比

耿  翔，黄加张，马  昕，王  旭，张  超，陈  立，王  晨
  

  1. 复旦大学附属华山医院，上海市  200040
  • 收稿日期:2017-04-03 出版日期:2017-09-18 发布日期:2017-09-28
  • 通讯作者: 黄加张，副教授，博士，复旦大学附属华山医院骨科，上海市 200040
  • 作者简介:耿翔，男，1987年生，安徽省凤台县人，回族，2016年复旦大学毕业，博士，医师，主要从事足踝外科方面的研究。
  • 基金资助:
    上海市科委科研项目基金(14411969900)

A comparison between over-the-toe plaster slab and off-loading forefoot shoes following hallux valgus correction

Geng Xiang, Huang Jia-zhang, Ma Xin, Wang Xu, Zhang Chao, Chen Li, Wang Chen
  

  1. Huashan Hospital of Fudan University, Shanghai 200040, China
  • Received:2017-04-03 Online:2017-09-18 Published:2017-09-28
  • Contact: Huang Jia-zhang, M.D., Associate professor, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai 200040, China
  • About author:Geng Xiang, M.D., Physician, Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai 200040, China
  • Supported by:

    the Scientific Research Fund of Shanghai Science and Technology Committee, No. 14411969900

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被引次数

1

摘要：

文章快速阅读：

 

文题释义：
拇外翻矫形：足拇外翻畸形是困扰女性的常见疾病，不但影响外观，还可能给日常穿鞋和行走带来极大不便。拇外翻矫形手术是足踝外科最常见的手术操作之一，矫形不但常常需要术中精细的截骨操作，更需要术后足够的固定及制动以保证截骨愈合。传统的术后固定方式为短腿超趾石膏托固定6周左右，但患者时常抱怨石膏固定过程中出现不适甚至疼痛，活动不便等，这也往往成为拇外翻患者对矫形手术望而却步的原因之一。
前足减压鞋：属于足部可穿戴式的特制支具，其最大的特点是支具后半部分提供支撑，而前半部分腾空，这样可以让穿戴者在行走时避免前足着地负重。对于拇外翻术后的患者而言，前足减压鞋理论上可以帮助患者尽早下床活动，并且能避免患者行走时前足的受力，但其具体的固定效果是否弱于传统石膏托固定，是否会延长术后骨质的愈合时间仍不得而知。
 
背景：拇外翻矫形是足踝外科最常见的手术操作之一，但术后传统的石膏托固定常常给患者带来极大不便和痛苦。前足减压鞋理论上可以帮助患者尽早下床活动，并且能避免行走时前足的受力，但其与传统石膏托固定相比的优劣仍不得而知。
目的：对比拇外翻矫形术后应用超趾石膏托与前足减压鞋的临床效果。
方法：回顾性分析2012年5月至2013年10月在复旦大学附属华山医院行远端Chevron截骨或Scarf截骨拇外翻患者的病例资料，根据术后固定方式的不同分为2组，对照组采用短腿超趾石膏托固定，试验组穿着前足减压鞋。术后6周行影像学评估，证实骨性愈合后解除固定；末次随访时进行临床评分及主观满意度调查，并记录随访期间并发症的发生情况。
结果与结论：①共125例患者(157足)完成随访，对照组83例(95足)，试验组42例(62足)，2组患者的一般人口学参数、术前术后影像学评估及临床评分、骨愈合时间、总体满意度差异无显著性意义；②但试验组患者出现跖趾关节或趾间关节僵硬、踝关节活动受限、手术侧踝关节以上疼痛的概率低于对照组(P < 0.05)，且若重新选择，试验组患者更愿意再接受相同治疗(P < 0.05)；③结果表明，与传统石膏托固定相比，前足减压鞋不但能维持矫形效果，还可减少关节僵硬、受限或肢体疼痛等并发症，更容易被患者主观上接受和认可，在拇外翻术后康复过程中应优先考虑。

关键词: 生物材料, 骨生物材料, 组织构建, 拇外翻, 前足减压鞋, 石膏托, 术后固定, 康复

Abstract:

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown.
OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction.
METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery. Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically.
RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However, Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction.

Key words: Hallux Valgus, External Fixators, Follow-Up Studies, Tissue Engineering

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