Austin截骨术治疗拇外翻

目的 探讨Austin手术治疗拇外翻的疗效.方法 自2000年至2005年,采用Austin手术方法治疗拇外翻患者89例169足.按常规治疗拇外翻的手术方法,松解拇趾跖外侧挛缩组织,显露跖骨头并切除内侧骨赘,跖骨内侧面"V"型截骨,截骨远端外移.结果 本组患者随访1～5年,优83例159足,良5例9足,可1例1足.术后无一例出现截骨延迟愈合及跖骨头缺血性坏死.结论 该手术方法操作简单,并发症少,疗效满意.     

Austin截骨术治疗拇外翻

目的探讨Austin手术治疗拇外翻的疗效。方法自2000年至2005年，采用Austin手术方法治疗拇外翻患者89例169足。按常规治疗拇外翻的手术方法，松解拇趾跖外侧挛缩组织，显露跖骨头并切除内侧骨赘，跖骨内侧面“V”型截骨，截骨远端外移。结果本组患者随访1～5年，优83例159足，良5例9足，可1例1足。术后无一例出现截骨延迟愈合及跖骨头缺血性坏死。结论该手术方法操作简单，并发症少，疗效满意。     

拇外翻的基础研究进展

本文从解剖，生物力学，病理等方面综述近几年的研究进展，认为其病因是多方面因素综合所致，最后都形成典型的病理改变。     

手术治疗中度拇外翻

目的寻找治疗中度拇外翻的最佳方法。方法回顾性分析采取小切口剥离拇收肌止点，切除第一跖骨头内侧滑囊及骨赘，治疗中度拇外翻患者16例（22足）。结果随访0．5～2．0年，疗效评定参照美国足踝矫形学会拇外翻评分标准．优良率100％。结论本方法操作方便，易于掌握，疗效满意，并发症少，有临床应用价值。     

介绍一种治疗足拇外翻新术式

足拇外翻是一种常见病,临床上发现部分患者第1楔骨远端内侧缘塌陷,第1跖骨内收,其轴线与第1楔骨纵轴线夹角增大,此夹角简称跖楔角。笔者通过第1楔骨远端截骨,经内侧楔形植骨矫正第1楔骨远端内侧缘塌陷,减小跖楔角治疗足拇外翻2例,效果良好,现介绍如下。1　材料与方法1.1　病例资料　病例1,男,52岁,发现右足拇外翻10余年,第1趾内侧肿胀、疼痛3年,曾行强的松龙局部封闭及小针刀治疗,但疗效欠佳,且外翻逐渐加重,行走时疼痛加剧。Ｘ线片测量,右拇趾向外倾斜35°,第1、2跖骨头部间距23ｃｍ,跖楔角25°。病例2,女,46岁,发现双足拇外翻5年,逐渐加重…     

改良Lapidus手术治疗拇外翻

目的分析改良Lapidus手术治疗拇外翻的疗效,并总结手术经验。方法自2004年4月～2008年4月,采用改良Lapidus方法治疗拇外翻患者16例21足,平均年龄54岁。术前症状为第1跖骨内侧拇囊突起疼痛,第2跖骨头下痛性胼胝,中足足背偏内侧疼痛。患者术前应力位摄X线片显示第1、2跖骨间角(IMA)平均17.4°(15.3～22.3°),拇外翻角(HVA)平均38.5°(32.2～50.4°),8侧足有第1跖楔关节骨关节炎表现。术前AOFAS评分平均46.7分。行改良Lapidus手术后,所有患者得到随访,平均随访17个月。结果术后所有患者都达到骨性愈合,均在术后3～4个月后完全负重。除1例患者术后2年复发第2跖底痛外,其余所有患者第1跖骨头内侧痛、第2跖底痛及足背痛症状消失,且无复发。术后IMA平均5.9°,HVA平均10.3°,术后AOFAS评分平均91.3分。结论 Lapidus方法纠正第1跖骨内收的中-重度拇外翻畸形,特别是伴有第1序列不稳或第1跖跗关节炎时非常有效。选择合适的患者,并在手术中注意操作细节,可避免并发症的发生。     

小切口截骨术矫正拇外翻

目的探讨小切口截骨术矫正拇外翻的治疗效果。方法对42例拇外翻患者共72只足实行小切口截骨术矫正治疗，手术后、术后1年X线检查并结合临床分析评价手术治疗效果。结果根据临床实际和X线检查结果并参考有关文献评定标准分析。小切口截骨术矫正拇外翻术后跟踪观察1^-年疗效：优60足(83．3％)，良10足(13．9％)，差2足(2．8％)。结论小切口截骨术矫正拇外翻。临床效果可信、稳定。     

Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients

Background

Postoperative pain is often severe after hallux valgus repair. Sciatic nerve blocks with long-acting local anesthetics have been recommended for surgical anesthesia and postoperative analgesia. However, a novel percutaneous approach may require less analgesia and make the procedure suitable for ambulatory care. We thus tested the hypothesis that mid-foot block and sciatic nerve blocks provide comparable surgical anesthesia and postoperative analgesia, but that patients ambulate independently sooner after mid-foot block.

Study design

Prospective, randomized study.

Methods

Forty patients scheduled for ambulatory percutaneous hallux valgus repair were randomly assigned to two anesthesia and analgesia blocks: foot infiltration achieved by a mild foot block, or sciatic nerve block (30 mL of 7.5% ropivacaine for each block). Surgery was performed without sedation or additional analgesia. Both groups were given oral paracetamol/codeine and ketoprofene systematically; tramadol was added if necessary. Walking ability and pain scores were assessed for 48 postoperative hours.

Results

Demographic and morphometric characteristics, and duration of surgery were similar in each group. Pain scores were comparable and low in each group at rest and while walking. The time to ambulation without assistance was significantly less for patients in the infiltration group (3.8 ± 1.4 hours) than patients in the sciatic group (19.2 ± 9.5 hours; P < 0.0001).

Conclusion

After percutaneous hallux valgus repair, mid-foot block and sciatic nerve block provided comparable postoperative analgesia. However, mid-foot block seems preferable since the time to ambulation without assistance is much reduced.     

改良McBride术式治疗(足母)外翻17例

拇外翻是骨科常见病,可发生于任何年龄,以女性多见.拇外翻的治疗,可供选择的手术方式很多,自1995年6月-2000年5月采用改良McBride术式矫正拇外翻畸形17例（25足）,术后经5年以上随访,效果满意,现总结报告如下.     

改良McBride术式治疗(足母)外翻17例

外翻是骨科常见病,可发生于任何年龄,以女性多见。外翻的治疗,可供选择的手术方式很多,自1995年6月-2000年5月采用改良McBride术式矫正外翻畸形17例(25足),术后经5年以上随访,效果满意,现总结报告如下。1临床资料本组共17例(25足),男2例(3足),女15例(22足);年龄20～57岁,     

Off-axis view radiographs for assessing hallux valgus interphalangeus in hallux valgus deformity: A comparison with the traditional anteroposterior standing radiographs

BackgroundThe newly described anteroposterior “off-axis view” (OAV) radiograph might help detect a hallux valgus interphalangeus (HVI) deformity more precisely compared to anteroposterior standing radiographs.MethodsA radiographic assessment of HVI angles was performed using preoperative standing anteroposterior and OAV radiographs for 67 ft. Intra- and interobserver agreement for all angles and their correlation with HV severity were analyzed.ResultsThe proximal-to-distal phalangeal articular angle showed less intra- and interobserver variance (intraclass correlation coefficient: 0.825) than did the other angles. OAV radiographs showed less interobserver reliability than did standing radiographs. HVI was underestimated significantly, by up to 5°, on standing radiographs compared to OAV radiographs (p < 0.001). The mean differences between OAV and standing radiographs were 3.7° and 5.0° for the proximal-to-distal phalangeal articular and hallux interphalangeal angles, respectively, and were more pronounced for moderate-to-severe HV deformities.ConclusionAngular measurements of HVI on traditional anteroposterior standing radiographs are significantly smaller than on OAV radiographs. Furthermore, angular measurements on OAV radiographs are associated with higher interobserver reliability. The most precise angle representing an HVI deformity might be the proximal-to-distal phalangeal articular angle.Clinical RelevanceOur findings may facilitate preoperative decision-making for additional akin osteotomy in HV correction.Level of EvidenceLevel II.     

The chevron osteotomy for correction of hallux valgus

Introduction The chevron osteotomy has become widely accepted for correction of mild and moderate hallux valgus deformities. The purpose of this study was to present the evolution of the chevron osteotomy at one institution over a period of 12 years. Methods Between April, 1991 and September, 1992, fifty-two consecutive patients with mild to moderate hallux valgus deformity underwent sixty-six distal chevron osteotomies at our institution. This was followed by 85 patients with 100 feet in the period from 1992 to 1995 and a group of 45 patients with 55 feet from 1994 to 1995. The final patient group included 61 patients with 89 feet operated from 2000 to 2002. Conclusion The chevron osteotomy is a reliable technique to correct hallux valgus deformities. Our recommendation after reviewing the results of the various modifications of the chevron technique revealed that the addition of a lateral release and a screw fixation will lead to the most reliable results.     

(足母)外翻足内侧足纵弓的初步研究

目的观察     

Postural stability impairment in patients with bilateral hallux valgus: A case-control study using a stabilometer

BackgroundHallux valgus (HV) is an important risk factor for falls (in older people); however, the detailed relationship is less understood. We aimed to evaluate postural stability in bilateral HV patients.MethodsTwo groups of 20 female patients—an HV group and a C (i.e., non-HV) group—participated in this study. Evaluations were made using the Timed Up and Go (TUG) test, the Berg Balance Scale (BBS), the Falls Efficacy Scale (FES), track length (LNG), velocity (VEL), enveloped area (ENV), and root mean square area (RMS).ResultsTUG and FES scores were significantly higher and BBS scores were lower in the HV group than in the C group. LNG was significantly longer, VEL was higher, and ENV and RMS were wider in the HV group than in the C group.ConclusionsThe HV group exhibited impaired walking mobility, balance, and postural stability.     

Austin手术治疗(足母)外翻的远期疗效分析

目的总结Austin手术治疗拇外翻5年以上长期随访结果，并进行疗效分析。方法利用Austin手术治疗拇外翻患者438例，其中91例176足获得随访，随访时间5-11年，平均7．8年；男12例20足，女79例156足；年龄23-81岁，平均47岁。术前、术后2周、术后5-11年摄负重位X线片，测量拇外翻角（HVA）、第一、二跖骨间角（IMA）、近端关节固定角（PASA）、远端关节固定角（DASA），并观察其变化。分别于术前及术后3-7年在足底应力测试仪上对18例患者36足测量足底应力，并将两组数据进行对比。结果根据Maryland第一跖趾关节百分评分法对所有患者进行评定，优126足（71．6％），良39足（22．2％），可11足（6．3％），优良率为93．8％。HVA较术前纠正14．2°（t=3．207．P〈0．01），IMA较术前纠正7．5°（t=2．304，P〈0．05），PASA较术前纠正8．3°（t=1．976，P〈0．05），DASA较术前纠正0．4°（t=0．216，P〉0．05）。术后第一跖骨头下负重增加，第二、三跖骨头处应力明显减少，第一至第五跖骨头下负重应力值趋于均匀。结论Austin手术截骨方法简单、稳定、不愈合率低、操作易掌握，是治疗第一跖趾关节无骨关节炎的轻、中度拇外翻患者的一种较好的、疗效可靠的手术方式。     

拇外翻诊断与治疗方法选择的探讨

正拇外翻(hallux valgus,HV),是指足拇趾偏离中线,向外倾斜大于正常生理性拇外翻角度,俗称为"大脚骨"或"大觚拐"。可在拇趾跖趾关节内侧骨性凸起处形成疼痛性滑囊即拇囊炎,经常伴有其余足趾的畸形和前足痛等症状,如锤状趾、疼痛性胼胝、跖趾关节脱位、小趾内翻等~([1])。拇外翻是足踝外科常见疾病,有关拇外翻的诊疗文献很多,现就几个热点问题做     

Surgical correction of hallux valgus deformity in children with cerebral palsy

Objective

This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.