Chinese Journal of Tissue Engineering Research ›› 2018, Vol. 22 ›› Issue (7): 1056-1065.doi: 10.3969/j.issn.2095-4344.0117
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Mao Wei, Zhang Jian-zhong, Sun Chao, Wang Xian-jun, Li Hai-tao
Online:
2018-03-08
Published:
2018-03-08
Contact:
Zhang Jian-zhong, Chief physician, Professor, Department of Ankle Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100016, China
About author:
Mao Wei, M.D., Attending physician, Department of Ankle Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100016, China
CLC Number:
Mao Wei, Zhang Jian-zhong, Sun Chao, Wang Xian-jun, Li Hai-tao. Geometric features of proximal closing wedge osteotomy in the treatment of hallux valgus [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(7): 1056-1065.
2.1 研究1的结果 IMA对比:组间IAM矫正程度对比,差异均有显著性意义(P < 0.007),见表1。B点为截骨定矫形结果最好,截骨角度为10°,15°时,可以将IMA矫正为3.5°,0°。而A点在相同截骨角度为时,可以将IMA矫正为7.5°,2°,这样的结果理论上符合临床矫形要求。C、D两点的矫正程度较差,在相同的矫正程度下,仅能将IMA理论值矫正到6°,7°,如果患者的IMA>16°,从研究结果看,需要加大截骨的角度,才能满足矫正要求。总体来看,截骨角度相同,楔形截骨的顶点越靠近关节,获得的矫形结果越大。10°-15°的楔形角度,比较适合临床于临床使用。 跖骨长度对比:组间跖骨长度的对比显示各组之间对比差异均有显著性意义(P < 0.009),见表1。选择D点为截骨顶点时,在相同的截骨角度下,所造成的跖骨短缩最小,在截骨角度为10°与 15°时,跖骨短缩分别为1.25 mm与2.00 mm。而B点为顶点时,跖骨长度短缩分别2.3 mm与3.5 mm,两者相差将近1 mm,绝对短缩达2.0-3.0 mm。而A点时,跖骨长度分别短缩1.8 mm与2.9 mm,与B点结果对比,平均相差0.5 mm,比较使用于临床。总体来看,在相同的截骨角度下,楔形截骨的顶点越靠近关节,所造成的跖骨短缩越大。 DMAA对比:组间DMMA对比显示各组组间比较均有统计学意义(P < 0.05),见表1。A点、C点、D点发现在楔形角度为5°,10°,15°,20°的情况下,DMAA逐渐增大,其中A点增大最小,在楔形角度10°-15°范围,DMAA增大在1.5°-3°。D点增大最多分别是3°-6.5°,C点居中。但在B点测得的结果比较特殊,楔形角度不同的情况,测量的DMAA无明显变化,通过进一步测量,得知由于B点在位置上更靠近端,裁剪后的第一跖骨轴线在跖骨近端发生变化明显,但在跖骨远端发生重叠,另外用测量用精度为1°的量角器,对于测量小于1°甚至小于0.5°的数值确实有一定困难。以至在DMAA的测量上,角度始终未发生明显变化。 总体看来,在同样的截骨角度下,越靠近关节,DMAA变化越小;越靠近远端,DMAA越易增大。 2.2 研究2的结果 IMA与DMAA的对比结果:发现3组的结果对比差异无显著性意义(P > 0.05),见表2。 跖骨长度对比结果:3组对比,组内与组间差异均有显著性意义。在相同程度的楔形角度时,选择A点为截骨顶点所造成的跖骨短缩最为明显,如在临床楔形截骨角度10°-15°时,跖骨短缩分别为1.8至2.9 mm。而在A’,A’’点时,短缩分别为1.3至2.5 mm,0.8至1.1 mm。由此推论,初步认为,越是靠近跖骨中线,造成短缩的程度越小,见表2。 本次测量并未在IMA及DMAA方面发现3组之间差异有显著性意义,但通过做图,作者发现,3组在进行5°,10°,15°及20° 时所获得的跖骨轴线确实有不同,但其差别小于1°。由于测量工具精度与测量技术有一定局限性,所以测出的结果在统计分析中未发现明显差异。 2.3 研究3的结果 在跖骨长度,IMA,DMAA方面,以上3组之间的对比差异无显著性意义。在以A点为顶点的楔形截骨,楔形角度相同的情况下,不同的截骨角度,IMA、跖骨长度及DMAA的的变化结果相似。也就是说,截骨顶点固定,楔形截骨角度固定,跖骨长度不会因近端截骨斜率不同而发生明显变化,见表3。 通过研究1,2,3,总结基底闭合截骨存在以下规律:①楔形截骨角度相同时,截骨顶点越靠近端,所获得的矫形越大,DMAA的改变越小,但造成的短缩越明显;②在同一跖骨水平线(与第一跖楔关节内外侧连线平行)任意一点作为截骨顶点,IMA、DMAA改变相似,但截骨顶点越靠近跖骨中线,所引起的跖骨短缩越小;③截骨顶点固定,楔形截骨角度固定,截骨初始倾角不同,IMA,跖骨长度及DMAA结果相同。 在截骨角度相同的情况下,就研究本身而言,针对IMA15°以上的拇外翻患者,截骨角度控制在15°以下,截骨顶点选择A或B点较为合适,矫形后的IMA可以达到一个满意的程度。 2.4 研究4结果 见表4。 IMA对比:截骨锯片垂直于水平面在截骨角度为10°与15°的时候,IMA分别为5°,1°。而后者分别为6°,2°。2组的对比差异有显著性意义(P < 0.05)。 跖骨短缩对比:当锯片垂直于水平面时,在楔形角度位10°与15°时,跖骨分别短缩1.4 mm与3.2 mm。而后者分别是1 mm与3 mm。两者之间的差异有显著性意义(P < 0.05)。跖骨头抬高对比:垂直于跖骨干截骨所得结果明显大于前者,在以15°为楔形截骨时,抬高达到5.6 mm,即使在10°的截骨量下,抬高也达到了3.8 mm。而前者所获得的测量值在统计分析时,差异无显著性意义(P > 0.05)。 "
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