The Clinical Standardization Study Of Integrated Treatment Of Hallux Valgus Of Chinese And Western Medicine

1A research backgroundHallux valgus(HAV) is a common foot deformities.Mainly occurred in the 14 to 70-year-old female,male to female ratio was 1:20.The main clinical manifestations of the former deformity and pain,limited walking shoes,seriously affecting the quality of life of patients.Hallux valgus Chinese Name absence,but tendon injuries can be attributed to the "bone from the joint,the tendons trough" or arthralgia syndrome areas.Chinese medicine theory:Kidney Health main bone marrow,and feeble-Shing,liver and kidney inadequate,their debilitating,long-term fatigue,bone loss can be caused by the reinforcement beam and the hallux valgus deformity.Hallux valgus the early and mid-simply a Hallux valgus deformity,yet lead to other diseases, but the normal anatomy of tendons biased position,it is taking tendons,tendon distortion;if the latter part of the medial toe pain,or pain associated with plantar,and other abnormalities,limited walking foot and toe joint flexion and extension disadvantaged,shall be vested in the arthralgia syndrome.Hallux valgus pathological mechanism of the main events:Western medicine think of that①biomechanics②arthritis③neuromuscular of④traumatic.Tutor-Jianmin to the point made by Professor①Hallux valgus exist in the development of yin and yang balance,that is, inside and outside,back,the plantaris muscle tendon imbalance of yin and yang.②hallux valgus exist in the development "from the bone joints,tendons a trough" pathological mechanism.There are many ways to traditional treatment to Hallux valgus more than 200, into six categories:①thumb cyst resection and soft tissue surgery;②the first metatarsophalangeal joint angioplasty;③osteotomy of the first metatarsal head and neck of the stem;④plantar Bone basement osteotomy;⑤special operation;⑥toe Prosthetic replacement.Traditional surgery,large incision,soft tissue injury,the need for fixed and fixed plaster,the patient suffering,recovered slowly after Shimoji late, high recurrence rate,there will be pain under the metatarsal head and other complications.20 since the end of the 1980s,mentor,Professor Wen Jianmin treated Hallux valgus at home and abroad and concluded on the basis of experience with complex fracture of the entire Chinese medicine approach,small splint pressure pad of paper Principle and the experience of Chinese medicine treatment of fractures, created the Integrated Treatment of Hallux valgus,renovation methods.Hallux valgus against the etiology and pathology at the same time dealing with,and achieved good results.Won many provinces,ministries,state-level awards.And promotion throughout the country,Hallux valgus patients cured of 2 million people.This treatment method is simple,orthopaedic satisfied with less recurrence of deformity, less postoperative pain,without internal fixation after Shimoji early,rapid recovery, fewer complications,is the best way for Hallux valgus.However,in the promotion of the technology in the course of some of the awareness and operational errors,thus affecting surgical treatment.In order to improve Hallux valgus in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients,the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization postoperative rehabilitation and efficacy evaluation system.To describe the standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the system of clinics,we have adopted a multi-center, and self-control before and after,standardization programmes compared with the traditional large incision research methods to four Centre at 200 hallux valgus feet Clinical comparison.Including①A retrospective study;②Integrated Treatment of Hallux valgus standardization of treatment(standardized research programme,standardized multi-center study programme with the traditional standardized large incision control study)③Anatomical study.2 A retrospective study2.1 Purpose of the study:Integrative Medicine will be confirmed excellently in the treatment of hallux valgus,and find inadequate.2.2 Materials and Methods1996 to 1999 of 150 feet 79 cases of hallux valgus,in accordance with their own before and after contrast control methods,observing and analyzing HAV,IM,and other indicators,the effect of the introduction of the new evaluation criteria,through SPSS13.0 statistical software for data analysis to study the effectiveness of the treatment method.2.3 Results2.3.1 Integrated Treatment of hallux valgus was verificated by clinics,effective, excellent rate 92%.Integrated Treatment of hallux valgus correction can be good of HAV,IM,Ⅰ-Ⅱmetatarsal head distance and TSP,and other parameters(P＜0.01).Ⅱ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) after a 91.8% improvement.Excellent rate is 92%.Proof of integrative medicine verificated effectively treatment of hallux valgus deformity.2.3.2 The urgency of the standardization of integrated Treatment of hallux valgus2.3.2.1 Insufficients founded from retrospective study:①Thumb varus after 2 feet(1.3 per cent).Analysis of this group in the thumb inversion reasons:1 overkill;2 a lack of regular inspection and promptly corrected.②Postoperative residual mild to moderate hallux valgus 40 feet(26.7%), analyzing the reasons:a serious patients hallux valgus,past a cerebrovascular accident;lateral joint capsule contracture,the hallux valgus feet of three different levels were using the same surgical procedure to correct,the lack of individualized treatment,the results are not quite satisfied.③Numbness of the District 4 feet(2.7 per cent).Toe with the medial branch of the superficial peroneal nerve in the subcutaneous course,can be hurt.④AfterⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) no improvement(or heavier) 8 feet of the former Chief of the corpus callosum (the corpus callosum pain) of 8.2 per cent of the total group to 5.3%of cases,it is caused by that deformities is not completely correct.2.3.2.2 Issues emerging from the process of Integrated Treatment of hallux valgus promoted at the grassroots level:①First metatarsophalangeal joint medial Osteophyte to cut excessive grinding metatarsophalangeal joint anastomosis poor,unstable distal metatarsal block(to the side and lateral plantar angle) of thumb inversion.②Osteotomy direction and angle of an overkill or being not completely correct.③Lack of exercise,restricted or part of the great toe activities restricted.④Necrosis induced by vascular injury in the toe and skin anesthesia of numb toes induced by nerve damage.2.4 Conclusion2.4.1 Integrated Treatment of hallux valgus is effective,high rate of 92%.2.4.2 Integrated Treatment ofhallux valgus clinics system standardization is essential.3 Integrated Treatment of hallux valgus standardized research3.1 Purpose of the study:①In view of the Integrated Treatment of hallux valgus the existing problems, the team developed a standardized clinical diagnostic criteria and classification standards,standardization of operational procedures,and standardization of evaluation and postoperative rehabilitation programme.Hallux valgus benefit of the increase in the combined treatment of traditional Chinese and western medicine to further promote this new technology for the benefit of the broad masses of Hallux valgus patients.②On standardization and certification of the Integrated Treatment of Hallux valgus the scientific nature of the treatment programme.3.2 Materials and Methods2006～2007 200 feet hallux valgus study,which①hallux valgus of 170 feet (110 feet WanNing Hospital;electricity hospital 30 foot;Guang'An Men hospital 30 feet) using standardized programme has been developed by the standardization of processes Classification and treatment,and a multi-center,and self-control method before and after contrast②30 feet hallux valgus(Metallurgy Hospital 30 feet) using traditional large incision,according to the surgical technique maturing(Austin, Mitchel) treatment,and adopt standardized Programme(WanNing Hospital 30 feet) contrast with the traditional large incision approach.Observation HAV,IM,such as 10 AOFAS indicators,and through SPSS13.0 statistical software for data analysis, research and verify the standardization of Integrated Treatment of Hallux valgus clinics programme effectiveness in the promotion of science and the application of feasibility.3.3 Results3.3.1 Standardized Integrated Treatment of Hallux valgus clinics programme has been verificated by clinical test results significantly.Excellent rate of 99.1%,and non-standardized Programme(retrospective study) ratio has been remarkably improved,the excellent and good rate increased 7.1%.110 feet hallux valgus(WanNing Hospital) using standardized clinics and treatment programmes for a division,and through its own method of comparing before and after the study.Most observed before and after surgery,the difference was significant(P＜0.01).HAV correction after an average of 21.03°±2.00°(HAV correction of mild group 16.05°±0.49°;moderate group Correction HAV 20.79°±3.67°;severe correction group HAV 25.98°±0.31°);IM angle correction average 4.69°±0.19°(correction mild group IM 2.39°±0.24°;Correction moderate group IM 4.31°±1.17°;severe group Correction IM 7.26°±1.25°); TSP after correcting average 2.74±0.22(TSP mild group correction 2.48±0.37; moderate group TSP Correction 2.70±0.14;severe group TSP Correction 3.06±0.01);AOFAS score after an average of 31.52±11.01 points(including mild group AOFAS increased 30.62±10.73 points;moderate group AOFAS raise 31.18±10.45 points;severe group AOFAS increased 32.75±12.34 points).Proved that the significant effect of standardization programme,the excellent and good rate 99.1%.3.3.2 Standardized Integrated Treatment of Hallux valgus in the clinics programme Wangjing Hospital,Guang'An Men hospitals and electricity Hospital three Center application,verified by clinical efficacy sure no difference. Excellent rates were 96.7%(Wangjing Hospital),93.3%(electricity Hospital), 93.3%(Guang'An Men Hospital).Hallux valgus 90 feet(30 feet Wangjing Hospital;electricity hospital 30 foot; Guang'An Men hospital 30 feet) using standardized programme type and treatment, and through multi-center,and self-control method before and after the study.①well the technology can correct HAV,IM,TSP,AOFAS(P＜0.01),and patient satisfaction. Validity of the standardized treatment programmes in the three centers promote the use of identification,excellent rates were 96.7%(Wangjing Hospital),93.3% (electricity hospitals,Guang'An Men Hospital).②three centers before and after surgery compared the observed difference,P＞0.05,shows that the standardization programmes in the three sub-centre applications no difference in efficacy.3.3.3 Wangjing Hospital and metallurgical hospital two centers were used standardized programmes and the traditional large incision two methods for Hallux valgus,the clinically proven efficacy determined that no difference, excellent rates of 96.7%(Wangjing Hospital,metallurgical hospitals); standardization programme is better than the traditional large incision technology.Hallux valgus 60 feet(30 feet Wangjing Hospital;metallurgical hospital 30 feet) were used standardized programmes and the traditional large incision and clinics through a multi-center,and self-control method before and after the study.①a standardized test in the treatment of hallux valgus with the large incision can be the same technical effect(two centers of the observed before and after surgery,all P＜0.01;the observed difference compared before and after surgery,all P＞0.05), Wangjing Hospital and metallurgical hospitals are excellent rate 96.7%.②standardization programme is better than large incision technology:In thumb after varus,hallux valgus,the toe area of numbness,swelling of the foot time and postoperativeⅡ,Ⅲmetatarsal head of the corpus callosum(the corpus callosum pain) occurred,Wangjing Hospital is less than Metallurgical hospitals,because of a standardized system injury two small clinics standardization.Chinese Herbs topical, Blood Circulation,swelling pain,Bushen Zhuanggu.Traditional large incision technique is 7-10 cm incision,spinal anesthesia,suture,the need for a fixed, tourniquet,the second surgery,go after a long time,the characteristics of the injury, poor compliance of patients.The minimally invasive technique is less than 1 cm incision,local anesthesia,no suture,internal fixation,tourniquet and secondary surgery,injury,after Shimoji can walk,welcomed by the overwhelming majority of patients,and good compliance.3.4 ConclusionThrough 200 feet hallux valgus a multi-center,and self-control and the method of contrast studies of standardization programmes and the traditional large incision technology,by the clinical test,confirming that the standardization of integrated treatment of Hallux valgus programme of clinics significantly;Application at the centre of identification,and no difference in efficacy;standardized in Integrative Medicine clinic programme will be with traditional large incision of the same technology,and technology is superior to the traditional large incision.4 Anatomical study4.1 The purpose of the study:①Understanding of combining traditional Chinese and western medicine treatment of hallux valgus minimally invasive technique of anatomical structure of the foot②Clear surgical operation and key peripheral vascular,neurological③Improve relations between the location of Integrated Treatment of the hallux valgus minimally invasive technique to study and verify④The safety of surgical operations.4.2 Materials and MethodsAnatomy of formalin solution immersion foot six,research and verify the safety of surgical incision and release.4.3 ResultsThrough anatomy of formalin solution immersion foot six,combining literature and anatomical map,the safety of surgical incision and release has been verified.①Lateral structure release,not great toe injury fibular dorsal metatarsal artery and plantar artery,not the thumb injury to muscle in the basement near the toe section only,not deep peroneal nerve injury. ②Osteotomy of the first metatarsal head and neck,thumb injury will not be long,short stretch,the flexor tendon and muscle tendon thumb exhibition,may hurt the medial dorsal foot nerve and a branch of the saphenous vein in the great toe back inside the branch,Because of the foot is rich in compensatory vein network,therefore osteotomy is safe.③Through the relocation of the distal osteotomy,the initial resumption of the first metatarsal seed system and the first metatarsal head of the anatomy of normal relations is true.4.4 ConclusionAnatomy analysis confirmed that the standardization programme is safe and feasible.5 Topics innovation①Creation of a standardized Integrated Treatment of Hallux valgus in the diagnosis,treatment,rehabilitation and efficacy evaluation system.The first multi-center,and self-control before and after the method has been applied to Integrated Treatment of Hallux valgus in the study.