Akin 截骨术联合 Scarf 截骨术治疗中重度 外翻

摘要： 目的 评价 Akin 截骨术联合 Scarf 截骨术治疗中重度 外翻的效果。方法 选取中重度 外翻患者 39 例（58 足）， 其中 12 例（16 足）中度 外翻患者采用单独 Scarf 截骨术， 27 例（42 足）中重度 外翻患者采用 Scarf 联合 Akin 截骨术。手术前、 后均行患足 X 线片检查， 测量 外翻角 （HVA）、 第一二跖骨间角 （IMA） 和胫侧籽骨位置， 记录患者术前术后美国足踝外科学会足功能评分系统 （AOFAS） 评分。结果 手术均顺利完成。每足手术时间 45~78 min， 平均 （55.0±6.8） min， 术中出血 3~20 mL， 平均 （11.0±5.4） mL。除 1 例 （1 足） 重度 外翻患者 Akin 截骨处愈合较慢以外， 其余患者 Scarf 及 Akin 截骨处均愈合良好。手术切口 2 例 （2 足） 出现红肿， 后自行消退。2 例 （2 足） 出现趾背内侧麻木， 考虑为神经损伤， 经 3~5 个月好转。本组患者均获得随访， 未见 外翻复发病例。术后 HVA （14.1°± 5.3°）、 IMA （7.7°±3.8°） 和胫侧籽骨位置 ［（2.58±0.61） 级］ 均低于术前 ［分别是 （39.6°±6.8°）、（18.7°±5.4°） 和 （4.87±0.59）级］， AOFAS 评分高于术前 （分： 84.4±8.7 vs. 37.3±9.5， P＜0.05）。结论 Akin 截骨术联合 Scarf 截骨术治疗中重度外翻疗效肯定， 矫形效果满意， 并发症少， 外翻复发率低， 值得临床推广应用。

Akin combined Scarf osteotomies for moderate and severe hallux valgus

Abstract: Objective To study the clinical efficacy of Akin combined Scarf osteotomies for moderate and severe hal? lux valgus. Methods Thirty-nine (58 feet) patients received Akin combined Scarf osteotomies, in which 12 patients (16 feet) with moderate hallux valgus received the single scarf osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position and American orthopedic foot and ankle society score (AOFAS) were measured and compared before and after operation respectively. Results All operations were successfully completed patients were followed up for 8- 22 months. The mean operation time was (55.0±6.8) min. The amount of intraoperative bleeding was 3-20 mL with an aver? age of (11.0±5.4) mL. All patients were healed except for a delayed union of Akin on a severe hallux valgus patient. Two cas? es (2 feet) were found inflammation in surgical incision. Two cases (2 feet) were found numbness in dorsal medial side of hal? lux, which was considered nerve damage and improved in 3-5 months. There was no recurrence of hallux valgus in the peri? od of following up. After surgery, HVA (14.1°±5.3°), IMA (7.7°±3.8°) and tibial sesamoid position (2.58±0.61) were signifi? cantly decreased compared with those before operation (39.6°±6.8°, 18.7°±5.4° and 4.87±0.59, P＜0.05). AOFAS score (84.4±8.7) was significantly higher after surgery than that before surgery (37.3±9.5, P＜0.05). Conclusion Akin combined Scarf osteotomies can achieve a excellent therapeutic effect for moderate and severe hallux valgus with very few complica? tions and recurrence, which is worth for clinical application.