探讨应用交叉中空加压螺钉联合背侧解剖接骨板的第一跖趾关节融合术治疗中重度拇外翻伴骨质疏松患者的临床疗效。

自2017年5月～2019年4月收集了46例中重度拇外翻伴骨质疏松患者，年龄65～73岁。观察患者的融合率情况以及术后相关并发症的发生率，分析比较了术前和末次随访时的拇外翻角(HVA)、第一二跖骨间角(IMA)、美国矫形足踝协会足功能评分(AOFAS)以及视觉疼痛模拟量表评分(VAS)。术前、末次随访比较采用t检验。

对46例患者进行了6～22个月的随访。46例中重度拇外翻伴骨质疏松患者全部实现了临床上和影像学上的第一跖趾关节融合，全部达成了早期负重活动的目的，末次随访时发现切口全部一期愈合，无相关并发症出现。术前HVA为(41.8±7.6)°，术后HVA为(15.6±1.6)°；术前IMA为(18.3±1.9)°，术后IMA为(9.6±1.3)°；术前AOFAS为(49.7±4.7)分，术后AOFAS为(81.6±2.9)分；术前VAS为(8.9±0.9)分，术后为(1.7±1.1)分。患者HAV、IMA、AOFAS、VAS在术前和末次随访差异有统计学意义(t＝23.75、27.28、-35.94、36.78，均为P<0.05)。

对于中重度拇外翻伴骨质疏松患者来说，应用交叉中空加压螺钉联合背侧解剖接骨板的第一跖趾关节融合术矫形效果满意，融合率高，康复快，值得临床推广。

To explore the clinical effect of the first metatarsophalangeal joint fusion with cross hollow compression screw and dorsal anatomical plate in the treatment of moderate and severe hallux valgus with osteoporosis.

From May 2017 to April 2019, 46 patients with moderate to severe hallux valgus and osteoporosis, aged 65-73 years, were collected. The fusion rate and the incidence of postoperative complications were observed. The hallux valgus angle (HVA), first and second metatarsal angle (IMA), American Orthopedic foot and ankle Association foot function score (AOFAS) and visual analogue scale (VAS) were compared before and at the last follow-up. Preoperative and final follow-up were compared by t test.

Forty-six patients were followed up for six to 22 months by outpatient follow-up. Forty-six cases of moderate and severe hallux valgus with osteoporosis all achieved clinical and imaging fusion of the first metatarsophalangeal joint, all achieved the purpose of early weight-bearing activities. At the last follow-up, it was found that all the incisions healed in the first stage, and no related complications occurred. Preoperative HVA was (41.8±7.6)° and postoperative HVA was (15.6±1.6)° respectively; preoperative IMA was (18.3±1.9)° and postoperative IMA was (9.6±1.3)° respectively; preoperative AOFAS was (49.7±4.7), postoperative AOFAS was (81.6±2.9) respectively; preoperative VAS was (8.9±0.9) and postoperative was (1.7±1.1). The differences of the two groups were statistically significant (t=23.75, 27.28, -35.94, 36.78, all P<0.05).

For patients with moderate and severe hallux valgus and osteoporosis, the first metatarsophalangeal joint fusion with cross hollow compression screw combined with the anatomical plate on the back is satisfactory, the fusion rate is high and the recovery is fast, which is worth clinical promotion.