摘要

CONTEXT:Hallux valgus is a common foot deformation in adults, but evidence for effectiveness of surgical and conservative treatments for this condition is limited.
OBJECTIVE:To compare the effectiveness of surgical and orthotic treatment with no treatment in patients with hallux valgus.
DESIGN AND SETTING:Randomized controlled trial conducted in 4 general community hospitals in Finland in 1997-1998, with a follow-up period of 12 months.
PARTICIPANTS:Two hundred nine consecutive patients (mean age, 48 years; 93% women) with a painful bunion and a hallux valgus angle 35 degrees or less.
INTERVENTIONS:Patients were randomly assigned to surgery (distal chevron osteotomy; n = 71), orthosis (n = 69), or a 1-year waiting list (control group, n = 69).
MAIN OUTCOME MEASURES:Pain intensity during walking on a visual analog scale (0-100), patient assessment of global improvement, number of painful days, cosmetic disturbance, footwear problems, functional status, and treatment satisfaction, compared among treatment groups.
RESULTS:Follow-up rates at 6 and 12 months were 99% and 98%, respectively. At 6 months, pain intensity decreased more in the surgical group than in the control group (adjusted mean differences, -20 [95% confidence interval (CI), -28 to -12]) and more in orthosis than in the control groups (adjusted mean difference, -14 [95% CI, -22 to -6. At 1 year, pain intensity decreased more in the surgical than in the control groups (adjusted mean difference, -19 [95% CI, -28 to -10]) and more than in the surgical and orthosis groups (adjusted mean difference, -14 [95% CI, -22 to -5]). At 1 year, 83%, 46%, and 24% in the surgery, orthosis, and control groups, respectively, thought they had improved compared with baseline (number needed to treat), 1.7 between surgical and control groups). Number of painful days, cosmetic disturbance, and footwear problems were least and functional status and satisfaction with treatment were best in the surgical group.
CONCLUSIONS:Surgical osteotomy is an effective treatment for painful hallux valgus. Orthoses provide short-term symptomatic relief.

译文

背景: 拇外翻是成人常见的足部变形,但手术和保守治疗这种情况的有效性证据有限。
目的: 比较外翻患者手术和矫形治疗与不治疗的有效性。
设计和背景: 1997年-1998 在芬兰 4 家综合社区医院进行的随机对照试验,随访时间为 12 个月。
参与者: 200 名连续 9 名患者 (平均年龄 48 岁; 93% 名女性),伴有疼痛性拇囊炎和拇趾外翻角度 35 度或更低。
干预: 患者被随机分配到手术 (远端 chevron 截骨术; n = 71),矫形器 (n = 69),或一年的等待名单 (对照组, n = 69)。
主要观察指标: 视觉模拟量表 (0-100) 上行走时的疼痛强度、患者对整体改善的评估、疼痛天数、美容障碍、鞋类问题、功能状态, 和治疗满意度,比较各治疗组。
结果: 6 个月和 12 个月的随访率分别为 99% 和 98%。在 6 个月时,手术组的疼痛强度比对照组下降得更多 (调整后的平均差异,-20 [95% 置信区间 (CI),-28 到-12]) 矫形器比对照组更多 (调整后的平均差,-14 [95% CI,-22 到-6。一年后,手术组的疼痛强度比对照组下降得更多 (调整后的平均差异,-19 [95% CI,-28 到-10]) 并且超过了外科组和矫形器组 (调整后的平均差异,-14 [95% CI,-22 到-5])。手术组、矫形器组和对照组在 1 岁时,分别有 83% 、 46% 和 24% 认为他们与基线相比有了改善 (需要治疗的数量), 1.7 外科手术和对照组之间)。手术组的痛苦天数、美容障碍和鞋类问题最少,功能状态和对治疗的满意度最好。
结论: 外科截骨术是治疗拇外翻疼痛的有效方法。矫形器提供短期症状缓解。

Hallux valgus

骨科 足趾畸形 疾病
概述  :  

踇外翻是常见的足趾畸形,主要表现为第一序列趾趾关节异常。早期踇外翻被称为第一跖趾关节肿大。随着研究的深入人们认识到踇外翻更应准确成为发生在跖趾关节的横向偏移。踇外翻发生涉及内因与外因多种因素,分析其发病危险因素有助于早期防治与延缓病情发展。 病因及病理基础足踇外翻畸形是足部最常见疾病之一,其发病存在内因与外因多种因素共同作用的结果。研究对临床常见的危险因素进行分析,结果发现重体力劳动者、习惯高跟鞋行走者、胫侧籽骨位置异常、第一跖趾关节矢状面活动度大于10度、内侧关节囊韧带损伤、籽骨

Hallux 英 /'hæləks/  美 /'hæləks/            

释    义   n. (人的)大拇趾;(脊椎动物的)后趾

复数 halluces

例    句   The time and locus of hand-motion of examiner, the time and angle of hallux-dorsiflexion, the muscle strength of the patients were recorded.记录检查者手部运动的背屈角度、持续时间和肢体肌力变化。

 

Valgus 英 /'vælgəs/

释    义   n. 外翻足的人;外翻足

adj. 外翻的

复数 valguses

同根词   lordotic adj. (某些雌性动物交配时)弓背姿势的;脊柱前凸的

例    句   These measures would prevent the cubitus varus or valgus deformity.上述措施可防止出现肘内翻或外翻畸形。


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