改良McBride加第1跖骨颈斜行嵌插截骨(Austin截骨)治疗拇外翻畸形的疗效

目的探讨改良McBride加第1跖骨颈斜行嵌插截骨（Austin截骨）治疗拇外翻畸形的疗效。方法对22例（36足）拇外翻畸形患者在改良McBride手术的基础上,行第1跖骨颈斜行嵌插截骨（Austin截骨）,截骨处行克氏针固定治疗。比较患者手术前后拇外翻角（HAV）和第1、2跖骨间夹角（IMA）矫正情况,参照美国足踝矫形学会拇外翻评分标准对患者进行疗效评定。结果 22例均获得随访,随访时间9～36个月,平均22.5个月。切口愈合良好,未出现截骨处延迟愈合、跖骨头缺血坏死、拇内翻感染及皮神经损伤导致的局部麻木。术后HVA平均为（12.7±0.1）°,较术前矫正（17.3±2.6）°;术后IMA平均为（8.6±1.6）°,较术前矫正（3.5±1.2）°。按美国足踝矫形学会拇外翻评分标准评分：优28足,良6足,差2足,优良率为94.4%。结论改良McBride加Austin截骨术治疗拇外翻,重建了足拇趾的软组织力量平衡,Austin截骨改善了第1跖骨的正常负重,矫形满意,截骨愈合率高,是治疗拇外翻的较好的手术方式。     

可吸收螺钉在踇外翻第1跖骨远端改良chevron截骨中的应用

背景：第1跖骨远端改良chevron截骨是治疗踇外翻的常用术式,应用可吸收螺钉进行固定的效果尚存争议。目的：评价可吸收钉在踇外翻第1跖骨远端改良chevron截骨中的应用效果。方法：对8例中度踇外翻患者行远端改良chevron截骨,V形截骨后采用1枚2.7mm可吸收螺钉固定,穿前足免负重鞋6～8周。结果与结论：纳入的8例患者均获随访,随访时间28～46个月。患者伤口均一期愈合,踇外翻角改善为15°～21°,平均（17.63±2.07）°;第1,2跖骨间角为7°～9°,平均（8.00±0.76）°;美国足踝外科协会踇趾-跖趾-趾间关节评分由术前的（70.13±7.10）分提高到术后的（92.75±7.30）分（P〈0.05）。说明远端改良chevron截骨后使用可吸收螺钉固定治疗轻中度踇外翻疗效可靠,是一种有效的固定方法。     

Scarf联合Akin截骨治疗中重度拇外翻畸形疗效分析

目的探讨Scarf联合Akin截骨治疗中重度拇外翻畸形临床疗效及手术指证。方法 68例108足中重度拇外翻畸形行Scarf截骨＋Akin截骨治疗,术后采用AOFAS评分联合X线片观察疗效及影像学改变。结果 68例获随访6~12个月;手术切口均一期愈合,截骨处愈合时间12周,无延迟愈合或不愈合,术后无并发症发生,治疗优良率96%;术后拇外翻角度、第1、2跖骨间角及胫侧籽骨位置（（5.70±1.25）°、（6.20±0.92）°、（2.48±0.51）级）均较术前（（40.20±5.43）°、（18.00±2.00）°、（4.98±0.65）级）明显下降（P〈0.05）,AOFAS评分（（88.30±7.06）分）较术前（（50.80±6.09）分）明显升高（P〈0.05）。结论 Scarf＋Akin截骨手术可技术互补,治疗中重度拇外翻畸形效果良好。     

Scarf截骨术治疗中重度足拇外翻的疗效分析

目的 探讨Scarf截骨术治疗中重度足拇外翻畸形的临床效果和优越性.方法 对2010年6月至2011年6月本院36例54足采用Scarf截骨术治疗的足拇外翻进行回顾性分析.对比患者术前、术后1年负重位X线片拇外翻角（HVA）和第一二跖骨间角（IMA）的变化,同时进行美国足踝矫形协会的足踝评分（AOFAS）.术前、术后各组数据采用t检验进行统计学处理分析.结果 所有患者均得到随访,平均随访时间为14.6个月（12～ 22个月）.足拇外翻畸形全部矫正,没有畸形复发.患者术前HVA平均为（35.38±5.21）°,术后为（13.41 ±2.14）°（P＜0.01）;术前IMA平均为（17.32±2.13）°,术后为（8.28±1.89）°（P＜0.01）;术前AOFAS平均为（46.23 ±9.14）分,术后为（81.36±11.27）分（P＜0.01）.结论 Scarf截骨术对于矫正中重度足拇外翻畸形效果显著.     

拇外翻矫形后并发症的特殊性

目的：探讨拇外翻术后并发症的起因及防治方法。 方法：于1994—03／2004—08选择河北医科大学附属第三医院骨科手术治疗的拇外翻畸形患者113例（186足）进行回顾性分析，其中选择Keller术式67例，Macbfide术式56例，Mitchell术式12例，Wilson术式18例，Scaffe术式4例，Loison术式20例，跖趾关节融合术9例。分析并发症原因，参照原术式、症状严重程度和患者要求采取针对性措施。首先保守治疗，无效则再次手术治疗。保守治疗包括理疗、按摩、主被动功能锻炼和支具固定等。手术参照并发症原因采取针对性措施。所有患者按美国足踝外科协会Maryland评分系统中拇跖趾关节评分标准评分，其中疼痛占40分，功能占45分（包括日常生活及体育活动10分，穿鞋情况10分，跖趾关节活动5分，趾间关节活动5分，关节稳定性5分，拇趾有无胼胝5分），外观占15分；90-100分为优，80-89分为良，70-79分为可，低于70分为差。 结果：术后2．5-41个月，平均13个月出现并发症，其中拇外翻复发6例，拇内翻3例，转移性跖骨痛10例，截骨处延迟愈合或不愈合3例，第l跖骨头坏死2例及第1趾列活动受限21例。该组患者首次术后评估，优97足（52％），良45足（24％），可31足（17％），差13足（7％），优良率为76％。针对并发症采取保守治疗38例，手术治疗7例，治疗后评估，优111足（60％），良61足（33％），可12足（6％），差2足（1％），优良率为93％。 结论：制定个性化治疗方案，出现并发症后进行针对性的康复治疗，可明显提高疗效。     

联合截骨在老年性严重拇外翻中的应用

目的探讨老年性拇外翻的手术治疗。方法自2008年3月至2010年1月期间用截骨矫形术共治疗拇外翻患者28例（31足）,男2例,女26例,患者年龄平均72.6岁,术前拇外翻角度平均（55±5）°,第一、二跖骨间夹角平均（18±4）°,根据畸形程度及类型选用不同的截骨,同时行拇收肌腱松解挛缩及切除跖骨头内侧骨赘及滑囊炎,结合术后康复训练。结果术后拇外翻角度平均（10±5）°,优25足,良6足。术后无切口感染、畸形复发、跖骨头无菌性坏死等并发症。结论截骨矫形术治疗老年性拇外翻的疗效满意。     

改良McBride手术治疗足拇外翻

目的探讨改良McBride手术治疗足拇外翻畸形的方法及疗效。方法在McBride矫形术的基础上，笔者采用拇内收肌切断后缝合在拇指关节囊内侧中部，保留腓侧籽骨；术后包扎时用绷带从第1、2趾蹼间通过做“8”字形包扎，将拇趾固定在内翻位约5°～10°。结果参照美国足踝外科协会拇趾-跖趾-趾间关节评分系统评估，优24足，良9足，可2足，优良率94．2％；本组病例患者无一例发生拇外翻复发。结论改良McBride手术宜选择中度拇外翻，未出现跖趾关节骨性关节炎的患者，它不做截骨，愈合快，可较快恢复功能。     

3D打印辅助第3代微创Chevron截骨术治疗轻中度■外翻的临床疗效

目的 探讨3D打印辅助第3代微创Chevron截骨术治疗轻中度■外翻的临床疗效。方法 以2021年4月至2022年4月沈阳医学院附属中心医院收治的轻中度■外翻患者为研究对象。选择其中采用3D打印辅助第3代微创Chevron截骨术根据治疗的25例（31足）患者为观察组,选择采用第3代微创Chevron截骨术治疗的25例（29足）患者为对照组。比较两组患者手术时间、住院时间、■外翻角（HVA）、第1～2跖骨间角（IMA）、术后1周视觉模拟评分（VAS）,以美国矫形外科足踝协会踝与后足功能评分（AOFAS）评定疗效。结果 观察组患者与对照组相比,手术时间短、住院时间长,差异有统计学意义（P<0.05）。术前,两组患者的HVA、IMA角比较差异均无统计学意义（P>0.05）;两组患者术后HVA、IMA角均得到明显改善（角度减小）,并且观察组患者的HVA、IMA角度小于对照组,差异有统计学意义（P<0.05）。观察组术后AOFAS各项评分均高于对照组,差异有统计学意义（P<0.05）。两组患者术后1周VAS评分差异无统计学意义（P>0.05）。结论 3D打印辅助第3...     

改良微创技术治疗拇外翻畸形65例分析

目的观察改良微创治疗拇外翻(hallux valgus deformity,HVD)畸形患者的治疗效果。方法借鉴国内外先进经验,采用局麻下微创手术治疗拇外翻畸形65例,使用微型动力操作系统微创截骨保留外侧少许骨皮质及骨膜,手法矫形、绷带外固定。结果所有患者均无并发症发生,足拇外翻畸形明显改善,随访6～36个月,手术优良率达98.35%。结论本微创手术效果可靠,简单易行,可作为矫正拇外翻畸形的较好方法。     

跖骨远端截骨、螺钉内固定治疗老年人蹲外翻23例

足躅外翻为女性常见病，病理机制尚不清楚，各种手术方式可达100多种。轻度躅外翻在老年人应当首先考虑保守治疗，而中度以上的躅外翻畸形者可行手术矫形。我科2004年12月至2006年11月采用跖骨远端截骨、皮质骨螺钉内固定治疗老年人足躅外翻23例23足，疗效比较满意。报告如下。     

Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus

Objective

To evaluate the correlation between the Manchester Grading Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) score in patients with a hallux valgus deformity.

Subjects and Methods

The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as the control group. The severity of hallux valgus, utilizing a relative nonmetric scale, the Manchester Grading Scale, and the metric AOFAS score, was determined for all individuals in the hallux valgus and control groups. SPSS version 18 (Chicago, Ill., USA) was used for data analysis.

Results

According to the Manchester Grading Scale, the 424 feet of the normal group were classified as ‘no deformity−. In the hallux valgus group, 85 feet were classified as ‘mild deformity−, 67 as ‘moderate deformity'' and 29 as ‘severe deformity−. The AOFAS total score in the control group was 99.14. In the hallux valgus group, patients with mild or moderate deformity had total scores of 86.20 and 68.19, respectively. For those with severe hallux valgus, the total score was 44.69 and the differences were statistically significant (p = 0.000). Using the Pearson correlation, strong negative correlations were found between the AOFAS score and the hallux valgus angle (HVA; r = −0.899, p = 0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatarsal angle (IMA) as well (r = −0.748, p = 0.000).

Conclusions

The AOFAS score was negatively associated with the Manchester Grading Scale, HVA and first IMA. As the severity of hallux valgus increased, the AOFAS score seemed to decrease.Key Words: Hallux valgus, Manchester Grading Scale, American Orthopaedic Foot and Ankle Society score     

No Midterm Benefit from Low Intensity Pulsed Ultrasound after Chevron Osteotomy for Hallux Valgus

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity. (E-mail: max_zacherl@hotmail.com)     

Link动力加压钢支架治疗踇外翻

目的探讨link动力加压钢支架治疗踇外翻的效果及其适应证。方法采用改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻13例,对术后疼痛缓解程度,关节活动和外形改善进行比较。结果 13例手术优良率为100%,术后未出现并发症。结论改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻效果良好。     

The study of surface electromyography used for the assessment of abductor hallucis muscle activity in patients with hallux valgus

Background: Hallux valgus is a common foot disorder. In patients with hallux valgus, the anatomy and biomechanics of foot is subject to alterations. Objective: The aim of this clinical and neurophysiological study is to compare the activity of abductor hallucis (AbdH) muscle between the group of patients with hallux valgus and control group of healthy people, with the use of surface electromyography. Methods: The study involved 44 feet with diagnosed hallux valgus (research group) and 42 feet without deformation (control group). The X-ray images, measurements of range of motion in the first metatarsophalangeal joint and in hallux interphalangeal joint, and the surface electromyography study recorded from AbdH muscle were performed. Results: Considering the amplitude of motor unit action potential, study participants with hallux valgus demonstrate significantly less activity of AbdH muscle than people without hallux valgus deformity. This activity is not dependent on the severity of valgus, age, or range of motion. Conclusions: It is speculated that the changes of the AbdH function may occur in the period before clinical appearance of hallux valgus deformity, or at the onset of distortion development. Further studies are needed for a comprehensive assessment of AbdH muscle in patients with hallux valgus.     

第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻

目的探讨第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻的疗效。方法以江苏省人民医院2010年1月至2017年8月收治的80例拇外翻患者为对象,共131足。其中中重度拇外翻68足,对此68足拇外翻患者均予以第一跖骨基底部楔形截骨联合改良Mcbride手术治疗,分析疗效。结果随访时间均为术后1年,拇外翻角、第一与二跖骨夹角、第一跖骨远端关节面角均小于术前,差异有统计学意义(P均<0. 01);并发症发生率为3. 33%(2/68)。术后1年VAS疼痛评分(1. 68±0. 12)分,较术前的(6. 65±0. 31)分降低(P <0. 01),AOFAS评分(89. 54±2. 36)分,较术前的(42. 38±3. 42)分升高(P <0. 01)。结论第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻,可改善患者症状,且并发症少,可有效缓解患者疼痛、促进足部功能康复。     

Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot

We hypothesized an association between foot type, foot deformity, and foot ulceration and conducted an analysis of a well-characterized, high-risk diabetic population of 398 subjects. The average age was 62 years of age and 74% of the study population were males. Foot-type distributions were 19.5% pes cavus (high arch), 51.5% neutrally aligned (normal arch), and 29.0% pes planus (low arch). We quantified the presence of hallux valgus (23.9%), hammer/claw toes (46.7%), and hallux limitus (24.4%). A significant association was found between foot type and hallux valgus (p = 0.003); pes planus feet had the highest prevalence as compared with neutrally aligned feet (odds ratio [OR] = 2.43, p = 0.0006). Foot type was also significantly associated with fixed hammer/claw toes (p = 0.01); pes cavus feet had the highest prevalence as compared with neutrally aligned feet (OR = 3.89, p = 0.001). Foot type was also significantly associated with hallux limitus (p = 0.006) with pes planus feet having the highest prevalence as compared with neutrally aligned feet (OR = 2.19, p = 0.003). However, foot type was not significantly related to any ulcer outcome (p = 0.7). Fixed hammer/claw toes (OR = 3.91, p = 0.003) and hallux limitus (OR = 3.02, p = 0.006) were associated with increased risk of any ulcer occurrence. This study affirms that foot type and foot deformity are related and that foot deformities are associated with ulcer occurrence.     

Outcome of the modified Lapidus procedure for hallux valgus deformity during the first year following surgery: A prospective clinical and gait analysis study

BackgroundThe modified Lapidus procedure is a surgical option to treat moderate to severe hallux valgus deformity with good radio-clinical outcome. However, comprehensive biomechanical outcome evaluation of this surgery at mid-term follow-up is missing. This study assesses and compares the radio-clinical and gait outcome at 6 and 12 months following modified Lapidus procedure.MethodTen consecutive female patients with moderate to severe hallux valgus who underwent modified Lapidus procedure participated in the study. Comprehensive gait assessment was performed preoperatively, at 6 and 12 months postoperatively. Gait parameters including spatiotemporal, kinematics and plantar pressure were analyzed using pressure insoles and 3-dimensional inertial sensors. Outcome was evaluated using two clinical questionnaires, i.e. the American Orthopaedic Foot and Ankle Score and the Foot and Ankle Ability Measure, and X-rays.FindingsThree spatiotemporal, two kinematics, and seven plantar pressure parameters significantly improved between 6 months and 12 months postoperatively. Significant improvement in radiological and clinical outcome was reported at 6 and 12 months. The Foot and Ankle Ability Measure showed non-significant improvement at 12 months.InterpretationThe outcome of this study is consistent with the previously reported good clinical and radiological results at one year following Lapidus for moderate to severe hallux valgus. Twelve gait parameters demonstrated that outcome improves from 6 months to 12 months postoperative with room for further improvement at long term. The gait outcome in this study confirms the longer rehabilitation period following modified Lapidus procedure. Studies with a larger sample size are required to confirm these findings.     

Finite element analysis of the foot: Model validation and comparison between two common treatments of the clawed hallux deformity

Background

Clawed hallux is defined by first metatarsophalangeal joint extension and first interphalangeal joint flexion; it can increase plantar pressures and ulceration risk. We investigated two corrective surgical techniques, the modified Jones and flexor hallucis longus tendon transfer.

Methods

A finite element foot model was modified to generate muscle overpulls, including extensor hallucis longus, flexor hallucis longus and peroneus longus. Both corrective procedures were simulated, predicting joint angle and plantar pressure changes.

Findings

The clawed hallux deformity was generated by overpulling: 1) extensor hallucis longus, 2) peroneus longus + extensor hallucis longus, 3) extensor hallucis longus + flexor hallucis longus and 4) all three together. The modified Jones reduced metatarsophalangeal joint angles, but acceptable hallux pressure was found only when there was no flexor hallucis longus overpull. The flexor hallucis longus tendon transfer reduced deformity at the metatarsophalangeal and interphalangeal joints but may extended the hallux due to the unopposed extensor hallucis longus. Additionally, metatarsal head pressure increased with overpulling of the extensor hallucis longus + flexor hallucis longus, and all three muscles together.

Interpretation

The modified Jones was effective in correcting clawed hallux deformity involving extensor hallucis longus overpull without flexor hallucis longus overpull. The flexor hallucis longus tendon transfer was effective in correcting clawed hallux deformity resulting from the combined overpull of both extensor and flexor hallucis longus, but not with isolated extensor hallucis longus overpull. An additional procedure to reduce the metatarsal head pressure may be required concomitant to the flexor hallucis longus tendon transfer. However this procedure avoids interphalangeal joint fusion.     

先天性马蹄内翻足跖骨排列与改良Mckay术后前足内收畸形的关系

目的：探讨先天性马蹄内翻足（CTEV）患儿的跖骨排列改变以及其与改良Mckav术后前足内收的关系。方法：对2000—2004年间我院行改良Mckay术治疗的CTEV患儿的患足摄术前、术后以及对照组健康足摄正位X线平片，根据自行拟定的标准进行测量前半足中轴线与各跖骨轴线的夹角及其与内外踝连线垂线的夹角．并进行对比、分析。结果：58例健康足的前半足中轴线分别与第1～5跖骨中轴线夹角的平均值均〈50．而患足与健康足之间比较，差异有显著性（χ^2=77．09，P〈0．01），证实CTEV的跖骨排列存在紊乱情况。术前跖骨排列紊乱程度与术后前足内收程度有关，差异具有显著性（χ^2=9．928，P〈0．05）。随着术前跖骨排列紊乱程度的加重，术后前足内收的危险性增高。结论：CTEV患足的跖骨排列存在一定程度的紊乱，其紊乱程度是造成术后前足残留内收畸形或畸形复发的主要原因之一。[著者文摘]