fa بررسی نتایج استئوتومی پروگزیمال متاتارس اول و روش ماک براید در بیماران با دفرمیتی هالوکس والگوس جراحی ارتوپدی Orthopedic Surgery پژوهشي Research <strong><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمینه و هدف</span></span></strong><span style="font-family:b mitra;"><span style="font-size:10.0pt;">: <span style="color:black;">دفورمیتی هالوکس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">والگوس یک بیماری شایع و ناتوان کننده میباشد. استئوتومی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پروگزیمال</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">متاتارس اول همراه با عمل ماک براید بونیونکتومی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">یک</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">روش</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شایع</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">برای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اصلاح</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">این دفورمیتی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">است</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">. </span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">هدف</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">این</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بررسی نتایج</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">این</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیمارستان رسول اکرم ایران می‌باشد.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;"></span></span></span></span><br> <strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">روش بررسی</span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">:</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">تعداد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">50</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مورد دفورمیتی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">هالوکس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">والگوس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در 48</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیمار</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مدت</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پنج</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">سال</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">(1389-1384) </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در بیمارستان رسول اکرم تهران</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">که با روش فوق درمان شده بودند تحت بررسی قرار گرفتند. در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">این</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میانگین</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زوایای هالوکس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">والگوس (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">HVA</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">) و بین</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">متاتارسی (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">IMA</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">) </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و درد</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> قبل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بعد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مقایسه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">همچنین میزان</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">رضایتمندی بیماران</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عوارض این عمل بررسی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شدند</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">.</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"></span></span></span><br> <strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">یافته</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ها</span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">:</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میانگین</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اصلاح</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زوایا</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">برای </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">IMA</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> و </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">HVA</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> به</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ترتیب 6.5 با </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">انحراف معیار </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">2.56 و 27.9 درجه با </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">انحراف معیار </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">1.65</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بود. در 28</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیمار (58%) رضایتمندی در حد خوب </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بود و</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> بین میزان اصلاح زوایا و رضایتمندی بیماران ارتباط معنی دار وجود داشت (056/0</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">p<</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">)</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">.</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> میانگین سنی بیماران 41 سال بود. </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">درد پس از جراحی در 38 بیمار (79%) کاهش و </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در 10 بیمار (20%) دامنه حرکات مفصل کاهش پیدا کرده بود.</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> در 4 بیمار (8%) جوش خوردگی نا مناسب با درجات خفیف دیده شد</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">. هیچ موردی از استئونکروز درسر متاتارس و عفونت و جوش نخوردن و دفورمیتی هالوکس واروس دیده نشد.</span></span></span><br> <strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">نتیجه</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">گیری</span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">:</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">استئوتومی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پروگزیمال</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">متاتارس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اول و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ماک برایدبونیونکتومی روشی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قابل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قبول</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">برای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اصلاح</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">هالوکس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">والگو</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">س با درجات متوسط تا شدید دربیماران با توجه به عوارض پائین و نتایج خوب این عمل در این مطالعه می</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">باشد</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">. </span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">درد </span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">باقیمانده</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و خشکی مفصل از عوارض عمده آن است.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;"></span></span></span></span> <strong>Background</strong>: Hallux valgus deformity is a common and debilitating disease. Proximal osteotomy of first metatarsal and Mc Bride b:union:ectomy procedure is a common procedure for this deformity.the goal of this study is to evaluate the result of this operation in Rasoul-e-akram hospital in Tehran.<br> <strong>Methods</strong>: 50 cases of hallux valgus deformity&nbsp;&nbsp; in 48 patients over a 5 years period who have been treated with this method were evaluated in Rasoul-e-akram hospital in Tehran. In this study mean of pre and post hallux valgus angle (HVA), intermetatarsal angle (IMA), and, pain were compared with each and also patient satisfaction and complications were evaluated<br> <strong>Results</strong>: The mean angles correction for hallux valgus (HVA), intermetatarsal (IMA) were 27.9 and 6.5 degrees respectively. Patient satisfaction was good in 28 patients and there was meaningfull correlation between angle correction and Patient satisfaction (p<0.05).mean age of patiens was 41. In 38 (79%) patients post-operative pain decreased and in 10 (20%) patients arch of motion decreased. In 4 patients (8%) subtle mal:union: were noted.there were no cases of metatarsal head osteonecrosis, non:union:, hallux varus deformity, and infection.<br> <strong>Conclusion</strong>: Proximal first metatarsal osteotomy and Mc Bride b:union:ectomy procedure is a reasonable procedure in Patints with moderate to severe hallux valgus deformity considering its low complication rate and good result in this study. Residual Pain and first MTP joint decreased arch of motion are the two main side effects. هالوکس والگوس, استئوتومی پروگزیمال متاتارس, روش ماک براید Hallux valgus, Proximal metatarsal osteotomy, Mc Bride procedure 16 20 http://rjms.iums.ac.ir/browse.php?a_code=A-10-1126-2&slc_lang=fa&sid=1 ali yegane علی یگانه yeganeh471@yahoo.com 3900319475328460043635 3900319475328460043635 No Department of Orthopaedics, Hazrate-rasol Hospital, Tehran University of Medical Sciences, Tehran, Iran. گروه ارتوپدی، بیمارستان حضرت رسول (ص)، دانشگاه علوم پزشکی تهران، تهران، ایران arash mottaghi آرش متقی drarash54@yahoo.com 3900319475328460043636 3900319475328460043636 Yes Department of Orthopaedics, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. گروه ارتوپدی، بیمارستان بعثت، دانشگاه علوم پزشکی همدان، همدان، ایران. kamal tabe-arjmand کمال تابع ارجمند drarjmand@yahoo.com 3900319475328460043637 3900319475328460043637 No Department of Orthopaedics, Hazrate-rasol Hospital, Tehran University of Medical Sciences, Tehran, Iran. گروه ارتوپدی، بیمارستان حضرت رسول (ص)، دانشگاه علوم پزشکی تهران، تهران، ایران gholamreza shahhoseini غلامرضا شاه حسینی drshahoseini@yahoo.com 3900319475328460043638 3900319475328460043638 No Department of Orthopaedics, Hazrate-rasol Hospital, Tehran University of Medical Sciences, Tehran, Iran. گروه ارتوپدی، بیمارستان حضرت رسول (ص)، دانشگاه علوم پزشکی تهران، تهران، ایران Hoseine Farahani حسین فراهینی dr.farahani@gmail.com 3900319475328460043639 3900319475328460043639 No Department of Orthopaedics, Hazrate-rasol Hospital, Tehran University of Medical Sciences, Tehran, Iran. گروه ارتوپدی، بیمارستان حضرت رسول (ص)، دانشگاه علوم پزشکی تهران، تهران، ایران