小切口治疗拇外翻畸形

小切口治疗拇外翻畸形中国中医研究院骨伤科研究所（北京１００７００）温健民，林新晓，杨巍，徐昭，张晖小切口（ＭｉｎｉｍａｌＩｎｃｉｓｉｏｎ）治疗拇外翻在美国等西方国家已被许多足外科医师所推荐，我所从１９８４年开始采用该法治疗拇外翻５００多例，现报导完整...     

拇收肌与拇囊筋膜瓣吻合治疗拇外翻

２２只拇外翻患足接受了拇囊筋膜瓣中１／３经第一跖骨头横孔与拇收肌吻合的矫形手术，经６个月￣４年的随诊，效果满意，优良率９０．９％。前足缩窄最大者达１０ｍｍ。６只足在术后３￣５个月，开始穿高跟鞋，经２￣３年随访无复发，但本术式不适用于拇外翻合并第一跖骨头关节面有倾斜者。     

拇外翻畸形的评估与手术治疗进展

拇外翻(hallux valgus,HV)畸形是足部常见的一种畸形,主要表现为拇趾外翻及第1跖趾关节半脱位或完全性脱位。随着畸形的进展,会表现出一系列的病理改变,如第1跖骨内收、拇趾外翻、第1跖骨头骨软骨损伤、第1跖趾关节炎、籽骨脱位、拇囊炎、跖籽关节炎、第1跖骨旋转、跖骨头倾斜以及交叉趾、锤状趾和跖痛症等,临床表现为前足疼痛、畸形,影响穿鞋以及功能障碍[1]。保守治疗不能缓解症状或影响日常生活时,应考虑手术治疗。目前报道的治疗拇外翻的术式超过100种[2],虽然手术方式的选择很多,但没有一种术式可以治疗所有的拇外翻畸形。手术治疗的目标是解除疼痛、矫正畸形、改善功能及穿鞋。目前,临床医生大多会根据拇外翻的病理特点选择联合术式,如骨性术式的联合或骨性术式与软组织术式联合。本文主要总结分析了拇外翻畸形的病因、病理特征与评估、矫形原则与常见术式选择、重度复杂性拇外翻畸形、微创技术和常见并发症,并对本期发表的相关文章进行点评。     

改良的Mcbride手术方法治疗拇外翻畸形

目的 探讨采用改良的Mcbride手术方法治疗拇外翻畸形临床应用的疗放。方法 对传统的Mcbride手术方法进行改良，术中的内侧切口改为“S”形，充分切除拇趾滑囊的内侧壁，只保留外侧壁用以覆盖骨赘切除后的骨粗糙面，切断拇收肌止点，在其下移的同时行外侧籽骨切除。结果 采用此手术方法为48例(62足)患者行拇外翻畸形矫治术，并进行两年以上的随访，总优良率达88．7％，疗放满意。结论 此手术方法针对拇外翻畸形的病理解剖及症状进行了有放的矫正，创伤小，恢复快。能较好地解除患者的痛苦，改善足部外观。     

微创手术矫正足拇外翻畸形的心理护理干预

目的:探讨足拇外翻微创手术治疗心理护理干预与临床疗效.方法:应用特制手术器械,经皮肤小切口锉除第一跖骨远端及跖骨近端的骨赘,用3-0可吸收性强生薇乔缝线在切口两侧真皮组织内纵向褥式缝合牵引固定跖趾关节,术后给予绷带"8"字形包扎.通过对这108例患者,168只足(手术)的资料进行回顾性分析.结果:所有患者均无并发症发生,足拇外翻畸形完全改善.随访8个月至8年,优良率为98.6%.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,术前早期心理护理干预,术中进行心理暗示疏导,使患者在生理与心理获得良好支持,加速伤口的康复.     

Keller关节成形术治疗拇外翻畸形31例

拇外翻是足部第1跖线的复合畸形,包括拇趾外翻及第1跖骨内翻畸形。自1999年1月～2004年6月,采用Keller术式治疗拇外翻31例39足,取得满意的疗效。1临床资料1.1一般资料本组31例39足,其中男10例(10足),女21例(29足);年龄50～71岁,平均61.2岁。左足9例,右足14例,双足畸形8例。术前     

再改良Keller与McBride手术治疗拇外翻畸形

本文报告了５１例，５６足姆外翻患者的改良Ｋｅｌｌｅｒ和ＭＣＢｒｉｄｅ手术治疗，优良率达９５％。作者重新分析了其成因与机制，认为与其遗传与穿鞋习惯为主要病因，而解剖上的先天肌力不均为其基础。并分析了两种手术的异同点。认为两种手术的共同点是姆内侧要以舌形筋膜紧缩关节囊等，姆外侧聚拢等第１、２跖骨头捆绑固定，以纠正跖骨内翻；而ＭＣＢｒｉｄｅ手术以彻底松解内侧软组织为手术成功的关键。本文对手术方法也分别作     

微创法治疗拇外翻畸形

目的：应用微创技术治疗拇外翻畸形。方法：应用外科微动力工具经趾骨基底部切口截除骨赘,经第一跖骨头内侧骨赘最高点处梭形横切口在跖骨头基底部行跖骨头斜形截骨,将跖骨远端外推、下推,用2-0可吸收线收紧内侧关节囊,缝合、固定、包扎。结果：32例患者外形改善明显,行走时疼痛症状消失或偶有疼痛。结论：微创法矫正拇外翻切口小、创伤小、恢复快。     

History of surgical treatments for hallux valgus

European Journal of Orthopaedic Surgery & Traumatology - In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue,...     

Salvage of recurrence after failed surgical treatment of hallux valgus

Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon’s factor, patient’s factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery.     

Morphology of the adductor hallux muscle and its significance for the surgical treatment of hallux valgus

The Mc Bride procedure for surgical treatment of the hallux valgus varies according to the different morphological features of the M. adductor hallucis. One hundred specimens of human adult feet-some with a hallux valgus deformity- were preserved in formaldehyde and examined under this aspect. The tendon of the M. adductor hallucis shows two heads-a caput transversum and a caput obliquum- and inserts at the basis as well as at the lateral sesamoid bone of the great toe. Morphological differences in type and place of confluence of both tendon heads give us a classification into 8 different types. In most cases the caput transversum inserted into the caput obliquum from the side and in the middle at the level of the lateral sesamoid bone of the great toe. In most cases, specimens with this muscle type showed a hallux valgus. In surgery of the hallux valgus deformity the tendon of the M. adductor hallucis should be detached from it insertion points in order to reduce the tension on the sesamoid bone and to prevent luxation. The insertion of the caput laterale of the M. flexor hallucis brevis at the lateral sesamoid bone should be left as it is.