McBride联合Akin截骨治疗合并痛风的轻度足母外翻

目的 探讨McBride联合Akin截骨治疗合并痛风的轻度外翻的临床效果.方法 回顾性分析我院手足显微外科于2011年2月至2015年1月采用McBride联合Akin截骨术治疗合并痛风轻度外翻患者疗效.共17例患者(23足),男4例(6足),女13例(17足).对患者采用McBride联合Akin截骨进行治疗.术前第一、二跖骨间角(intemetatarsal angle,IMA)平均为8.0°±1.5°,术前外翻角(hallux valgus angle,HVA)平均为23.5°±5.5°,根据美国足踝外科协会(American Orthopaedic Foot and Ankle Soci-ety,AOFAS)趾-跖趾-趾间关节功能评分标准评价术前评分,平均为(38.4±7.2)分.结果 患者均获得随访,随访时间为4~48个月,平均为26.8个月,截骨处切口愈合时间平均为12周,均一期愈合.患者第一跖趾关节疼痛消失,未出现术后转移性跖骨痛.术后IMA平均为5.5°±1.5°,术后HAV平均为12.5°±1.5°,术后AOFAS趾-跖趾-趾间关节功能评分平均为(86.2±3.6)分,分别与术前比较,差异均有统计学意义(均P<0.05).术后AOFAS趾-跖趾-趾间关节功能评分:15足为优、7足为良、1足为差,优良率为95.7%(22/23).结论 对于合并痛风的轻度外翻患者,采用McBride联合Akin截骨术,能有效地减小HVA,并较好地解除患者的疼痛,改善足部外形,获得满意疗效.

Curative effect of the McBride with Akin osteotomy to treat mild hallux valgus with gout

Objective To investigate the clinical effect of McBride and Akin osteotomy in the treatment of mild gynecomastia with gout. Methods The curative effectiveness of this method used in hand-foot surgery in our hospital was retrospectively analyzed from February 2011 to January 2015. A total of 17 cases (23 feet) were researched: 4 male cases (6 feet) and 13 female cases (17 feet) were treated by the McBride with Akin osteotomy. The average IMA of the first and second metatarsal angles (IMA) was 8° ± 1.5° and 23.5° ± 5.5° preoperatively, and the mean value of hallux valgus angle (HVA) was 23.5° ± 5.5° . The average score of preoperative evaluation was (38.4±7.2) points for the score of functional evaluation of the metatar-sophalangeal joint of the American Orthopedic Foot and Ankle Society (AOFAS). Results All patients were followed up for 4 to 48 months (mean 26.8 months). The healing time of the osteotomy was 12 weeks. The first metatarsophalangeal joint pain disappeared, and no postoperative metastatic metatarsal pain occurred. The average postoperative mean IAV was 5.5° ± 1.5° , and the mean value of HAV was 12.5° ± 1.5° and 86.2 ± 3.6 points respectively. There was statistically significant difference before and after operation ( P<0.05). For postoperative AOFAS score, 15 feet were excellent, 7 feet were good, and 1 foot was poor, with the excellent rate being 95.7%(22/23). Conclusion McBride combined with Akin osteotomy in patients with mild gynecomastia with gout can effectively reduce the increase of HVA, can better relieve the pain of patients and improve foot shape, and can obtain satisfactory curative effect.