2026 年第 9 期 第 21 卷

微创改良Bsch截骨术与微创截骨手法整复术治疗中重度外翻畸形的效果比较

Comparison of minimally invasive modified Bsch osteotomy and minimally invasive osteotomy with manual reduction for moderate to severe hallux valgus deformity

作者：郭芙莹1肖潇2梁佩文1张琼1孙旭东1危一飞1

英文作者：Guo Fuying1 Xiao Xiao2 Liang Peiwen1 Zhang Qiong1 Sun Xudong1 Wei Yifei1

单位：1中国中医科学院望京医院骨关节二科，北京100102；2首都医科大学附属北京中医医院妇科，北京100010

英文单位：1Second Department of Orthopedics and Joints Wangjing Hospital China Academy of Chinese Medical Sciences Beijing 100102 China; 2Department of GynecologyBeijing Hospital of Traditional Chinese Medicine Capital Medical University Beijing 100010 China

关键词：外翻；微创改良Bsch截骨术；微创截骨手法整复术

英文关键词：Halluxvalgus；MinimallyinvasivemodifiedBschosteotomy；Minimallyinvasiveosteotomywithmanualreduction

• 摘要：

• 目的 探究微创改良Bsch截骨术（改良MIBO）与微创截骨手法整复术（MIMR）矫正中重度外翻畸形的疗效。方法 回顾性纳入2022年11月至2024年4月于中国中医科学院望京医院接受改良MIBO（29例，54足）或MIMR（26例，46足）治疗的中重度外翻患者，随访≥12个月。比较2组美国骨科足踝外科协会（AOFAS）评分、放射学指标［外翻角，第一、二跖骨间角（IMA），关节面固有角（DMAA）］、视觉模拟量表（VAS）评分及并发症。结果 2组患者术后AOFAS评分方面，组间总分、疼痛、功能、对线评分差异均无统计学意义（均P＞0.05）；术后2组AOFAS评分较术前均显著升高（均P＜0.05）。VAS评分术后当天、3周及7周2组间差异均无统计学意义（均P＞0.05）。放射学指标显示，末次随访时2组外翻角、IMA、DMAA均显著低于术前（均P＜0.05），改良MIBO组末次随访时外翻角、IMA、DMAA角度均低于MIMR组（均P＜0.01），籽骨位置改善组间差异无统计学意义（P＞0.05）。亚组分析表明，中、重度患者中改良MIBO组末次随访时IMA均显著优于MIMR组（均P＜0.01），但重度患者的外翻角组间差异无统计学意义（P＞0.05）。2组并发症发生率组间差异无统计学意义（P＞0.05）。结论 改良MIBO与MIMR矫正中重度外翻畸形均有效，改良MIBO在放射学矫正上更具优势，安全性均良好。

• Objective To explore the clinical efficacy of minimally invasive modified Bsch osteotomy (modified MIBO) versus minimally invasive osteotomy with manual reduction (MIMR) in correcting moderate to severe hallux valgus deformity. Methods A retrospective study enrolled patients with moderate to severe hallux valgus who received modified MIBO (29 patients, 54 feet) or MIMR (26 patients, 46 feet) at Wangjing Hospital, China Academy of Chinese Medical Sciences from November 2022 to April 2024, with a follow-up duration of no less than 12 months. The American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic parameters ［hallux valgus angle, intermetatarsal angle (IMA) between the first and second metatarsals, distal metatarsal articular angle (DMAA)］, visual analogue scale (VAS) score and complications were compared between the two groups. Results There were no statistically significant intergroup differences in the total AOFAS score, pain subscore, function subscore and alignment subscore after surgery (all P＞0.05); the postoperative AOFAS scores of both groups were significantly higher than preoperative values (all P＜0.05). No significant intergroup differences in VAS scores were observed on the day of surgery, at 3 weeks and 7 weeks postoperatively (all P＞0.05). Radiographic measurements revealed that the hallux valgus angle, IMA and DMAA of both groups were markedly reduced at the final follow-up compared with baseline (all P＜0.05). The modified MIBO group presented smaller hallux valgus angle, IMA and DMAA than the MIMR group at the final follow-up (all P＜0.01), while no intergroup difference was found in sesamoid position improvement (P＞0.05). Subgroup analysis demonstrated that the IMA of both moderate and severe patients in the modified MIBO group was significantly superior to that in the MIMR group at final follow-up (both P＜0.01), whereas no intergroup difference in hallux valgus angle was detected among severe patients (P＞0.05). The incidence of complications showed no statistically significant difference between the two groups (P＞0.05). Conclusion Both modified MIBO and MIMR achieve satisfactory correction for moderate to severe hallux valgus deformity. Modified MIBO has advantages in radiographic correction, and both surgical techniques exhibit favorable safety profiles.