Scarf截骨治疗中重度[足母]外翻的短期疗效分析

背景：野外翻是最常见的前足畸形,越来越受到矫形外科医生的重视,其治疗方式多种多样,如何选择适合的手术方式是治疗成功的关键。目的：探讨Scarf截骨术治疗[足母]外翻的疗效。方法：2010年7月至2012年6月,我院采用Scarf截骨术治疗中重度跽外翻患者47例（61足）,男5例（7足）,女42例（54足）;年龄20-78岁,平均52．2岁。比较手术前后[足母]外翻角及第1、2跖骨间角纠正程度。采用AOFAS评分评估患者临床症状改善情况。结果：所有患者均获得随访,随访时间4-8个月,平均6个月。[足母]外翻角由术前42．6。减小至12．9°,平均减小29．7°。第1、2跖骨间角由术前18．4°减小至8．9°,平均减小9．5°。AOFAS评分由术前49．9分增加至术后86．2分,平均增加26．5分。并发症发生率10％。结论：Scarf截骨术治疗中重度躅外翻可以获得较好的短期临床结果,但需严格掌握手术适应证。     

选择性跖骨远端截骨治疗中重度(足母)外翻

[目的]探讨选择性跖骨远端截骨治疗(足母)外翻的手术适应证、手术方法及疗效.[方法]对2007年3月～2011年1月本院60例(101足)中度及重度(足母)外翻进行回顾性分析.双足41例,单足19例.其中女性57例,男性3例;年龄23～81岁,平均62.6岁.[结果]本组60例(101足)均获随访,随访时间6～48个月,平均22个月.参照美国足踝外科协会Maryland(足母)跖趾关节百分评分系统,90～ 100分40例(66足);80～89分16例(30足);70～79分4例(5足);优良率95％.术前HVA 30°～44°,平均36°;术后10.5°～21°,平均15.3°.IMA 13°～18°,平均16°;术后6°～10°,平均8.5°.第1跖趾关节活动度术前0°～30°,平均16°;术后为25°～50°,平均35°.第1跖骨长度较术前减少3 ～6 mm,平均4.2mm.[结论]本术式为软组织合并骨性手术,手术方法简单,创伤较小,跖骨头成形充分,术后不需要辅助内固定等优点,是一种值得推广的术式.     

改良Ludloff截骨联合Reverdin截骨治疗中重度足母外翻

目的 探讨改良Ludloff截骨联合Reverdin截骨治疗合并第一跖骨远端关节面角（distal metatarsal articular angle, DMAA）增大的中重度足母外翻的疗效分析。方法 回顾性分析自2015年2月至2017年2月我科治疗的DMAA增大的中重度足母外翻病人32例（40足）。其中,男4例（5足）,女28例（35足）;年龄为29~78岁,平均52.4岁。术前行足部负重位X线检查：足母外翻角（hallux valgus angle, HVA）为30°~55°,平均42.4°±3.30°;第一、二跖骨间夹角（intermetatarsal angle, IMA）为13°~24°,平均17.7°±1.9°;DMAA为17°~39°,平均22.6°±1.1°。行患足美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）评分标准评分为41~87分,平均（68.3±2.9）分。均采用改良Ludloff截骨联合Reverdin截骨。对比手术前后HVA、IMA及DMAA,参照AOFAS评分标准进行手术疗效分析。结果 32例病人术后获得6~18个月随访。所有病人无感染、骨折不愈合、跖骨头坏死及畸形复发等并发症的发生,有1足切口延迟愈合。术后6个月行X线检查,HVA为13.2°±3.1°、IMA为8.1°±1.7°、DMAA为7.6°±1.2°,以上指标较术前减小,差异均有统计学意义（均P＜0.05）。术后6个月AOFAS评分：优29足,良8足,可3足,优良率为92.5%。AOFAS评分为（77.0±3.0）分较术前升高,差异具有统计学意义（t=41.18,P=0.004）。结论 改良Ludloff截骨联合Reverdin截骨治疗合并DMAA增大的中重度足母外翻可以很好的纠正畸形。     

微创截骨张力带矫正足(足母)外翻

[目的]研究改良小切口手术治疗足躅外翻的新疗法.[方法]采用小切口手术治疗,行骨赘切取、跖骨颈斜形截骨、关节囊张力带矫正畸形、可吸收螺丝钉内固定、石膏托制动方法,术后6周去除外固定,可下床适当活动.随访26例,时间13～30个月,平均21个月. [结果]优26例(50足),占89.7％;良2例(4足),占6.94％;差1例(1足),占3 4％.优良率达96.6％.[结论]微创截骨张力带矫形治疗足(足母)外翻,手术简捷,术后恢复快,合并症少,畸形复发率低,是值得推广应用的新方法.     

Lapidus手术联合Akin截骨治疗中重度(足母)外翻近期疗效分析

[目的]探讨Lapidus 手术联合Akin截骨治疗中重度(足母)外翻近期疗效.[方法]回顾分析2009年1月～2011年3月,本院采用Lapidus手术治疗中重度(足母)外翻畸形患者39例50足,平均年龄(59.0±8.36)岁,其中A组Lapidus 手术患者16例23足,B组Lapidus+ Akin手术患者23例27足.所有患者术前、术后随访均拍摄负重位X线片,测量(足母)趾外翻角(HVA),第1、2跖骨间角(IMA).[结果]所有患者得到随访,平均随访时间24个月,所有患足第1跖楔关节都获得骨性愈合,所有患者末次随访HVA、IMA较术前明显改善,P＜0.01;末次随访HVA角度A组(19.84±6.27)°大于B组(15.18±6.96)°,P＜0.05;HVA平均矫正角度A组(18.87±7.70)°小于 B组(25.36±9.28)°,P＜0.05;B组远端关节面固有角(DASA)由术前平均(6.13±2.52)°纠正为(-5.80±3.16)°,平均纠正(-11.94±3.51)°,P＜0.01.[结论]Lapidus联合Akin手术治疗中重度(足母)外翻,与单纯应用Lapidus手术比较,可以更好地纠正前足畸形,更好的改善HVA角和(足母)趾外观,获得满意的疗效.     

小切口截骨术矫正(足母)外翻

目的探讨小切口截骨术矫正外翻的治疗效果。方法对42例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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外翻,临床效果可信、稳定。     

Chevron联合Akin截骨与Scarf联合Akin截骨治疗中度足母外翻的临床疗效对比

目的 比较Chevron联合Akin截骨术与Scarf联合Akin截骨术治疗中度足母外翻的临床疗效。方法 回顾分析江苏省中医院骨伤科2012年9月至2015年9月收治的27例（36足）中度足母外翻病人,Chevron联合Akin截骨组（CA组）14例（19足）,Scarf联合Akin截骨组（SA组）13例（17足）,比较两组术前、术后1个月、1年及末次随访时以下指标：足母外翻角（hallux valgus angle, HVA）;第1、2跖骨间夹角（inter metatarsal angle, IMA）;近端关节面固有角（distal metatarsal articular angle, DMAA）;胫侧籽骨位置;第一跖骨长度;另外,比较两组术前、术后末次随访的美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）评分。两组病人性别、年龄、术前HVA、IMA、DMAA、第一跖骨长度、胫侧籽骨位置的差异均无统计学意义（P均＞0.05）。结果 两组病人术中未见明显的并发症,术后均愈合良好,无骨折不愈合、延迟愈合、跖骨头坏死、皮神经损伤、内固定松动、僵直、足母内翻等并发症。术后末次随访CA组AOFAS评分为（93.91±9.03）分,SA组AOFAS评分为（91.83±13.58）分,两组比较,差异无统计学意义（t=0.552,P=0.593）。术后1个月、1年、末次随访时两组的HVA、IMA、DMAA比较,差异均无统计学意义（P均＞0.05）。与SA组比较,术后1个月、1年、末次随访时CA组第一跖骨长度短缩程度更大,第一跖骨疼痛发生率更高,而胫侧籽骨复位更理想（P均＜0.05）。结论 Chevron联合Akin截骨与Scarf联合Akin截骨治疗中度足母外翻均有较好的疗效,临床疗效相近。     

跖骨颈截骨内翻嵌插固定治疗(足母)外翻畸形

[目的]探讨跖骨颈斜行截骨内翻嵌插固定治疗疼痛性母外翻畸形的疗效。[方法]回顾该术式治疗36例(52足)疼痛性母外翻患者的临床资料,随访时限为2 a。手术前后均摄双足正侧位X线片,测量母外翻角及第1、2跖骨间夹角以判定畸形程度。并采用足部疾患治疗效果JOA评分并进行患足功能评分以评价其临床疗效。对该术式的适应证和并发症亦作了一定的探讨。[结果]术后骨愈合满意,无延迟愈合及不愈合情况,皮肤感染2例3足。术后2 a与术前相比,患者的母外翻角及第1、2跖骨间夹角平均矫正15.6°和4.2°,JOA评分提升29.6分。[结论]跖骨颈斜行截骨内翻嵌插固定可三维立体矫正母外翻畸形,是治疗疼痛性母外翻畸形的良好选择。     

(足母)长伸肌腱移位动力性矫正(足母)外翻畸形

目的探讨长伸肌腱移位动力矫正外翻畸形的机制及临床疗效。方法2004年4月～2006年12月,采用长伸肌腱移位矫治外翻畸形25例38足。其中男2例3足,女23例35足;年龄22～60岁,平均46.3岁。术前外翻角21～45°,平均31.30°;跖间角7～21°,平均12.52°。手术将第1跖骨骨赘凿除,内侧关节囊修复,收肌横头切断,长伸肌腱向内侧移位、止点再造。结果术后外翻角7.30±2.62°,跖间角6.50±2.46°,与术前比较差异均有统计学意义(P<0.05)。术后功能应用美国足踝外科协会趾-跖趾-趾间关节评分系统进行临床评估,优25足,良7足,差6足,优良率84.2%。获随访6～24个月。2足于术后2个月出现内翻,2足术后3个月出现第1跖趾关节活动受限。无外翻畸形复发。结论通过口止母长伸肌腱内移等软组织平衡恢复了第1跖趾关节内、外侧应力,手术操作简便,畸形矫正效果好且不易复发。     

Scarf截骨联合软组织平衡松解治疗重度拇外翻

目的：探讨Scarf截骨联合软组织平衡治疗重度拇外翻的手术疗效。方法：回顾性分析2019年6月至2021年6月采用Scarf截骨联合软组织平衡手术治疗的38例（50足）重度拇外翻患者的临床资料,男6例（8足）,女32例（42足）;年龄29～64(54.7±6.8)岁;左侧26足,右侧24足;病程5～23(12.4±3.9)年。比较手术前后拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）、跖骨远端关节面角（distal metatarsal articular angle,DMAA）,观察术后并发症发生情况。术前和末次随访时采用美国足与踝关节协会（American orthopedic foot ankle society,AOFAS）评分评价前足功能恢复情况,采用视觉模拟评分法（visual analogue scale,VAS）评价患者疼痛缓解程度。结果：38例患者（50足）均获随访,时间15～23(18.3±3.2)个月。HVA、IMA、DMAA术前分别为（44.61±3.92）°、（18.74±2....     

Mid-term results of Scarf osteotomy in hallux valgus

We performed a retrospective study on 178 Scarf osteotomies with a mean follow-up of 44.9 months (range 15–83 months). Clinical rating was based on the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Weight bearing X-rays were used to perform angular measurements and assess the first metatarsophalangeal joint (MTP 1). At follow-up the mean AOFAS score had improved significantly (p < 0.001), but only 55% of the feet showed a perfect realignment of the first ray. Patients with a hallux valgus angle exceeding 30° and pre-existing degenerative changes at the MTP 1 joint displayed inferior clinical results (p < 0.05). Nearly 20% of the patients suffered from pain at the MTP 1 joint. This was clearly attributed to an onset or worsening of distinct radiographic signs of arthritis (p < 0.05) resulting in painfully decreased joint motion. Comparing radiographic appearance three months postoperatively and at follow-up, we found that radiographic criteria (hallux valgus, first intermetatarsal angle, hallux valgus interphalangeus, MTP 1 joint congruency, arthritic lesions at MTP 1) worsened with time.     

旋转Scarf截骨术治疗拇外翻合并第1跖骨旋转

目的：探讨旋转Scarf截骨术治疗拇外翻（hallux valgus,HV）合并第1跖骨旋转的临床疗效。方法：自2018年1月至2019年10月采用旋转Scarf截骨术治疗35例（40足）HV合并第1跖骨旋转畸形患者,其中男5例,女30例;年龄25～76(40.32±5.43)岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1、2跖骨间角（intermetatarsal angle,IMA）,第1跖骨远端关节面角（distal metatarsal articular angle,DMAA）,第1跖骨长度（the first metatarsal length,FML）,术后采用美国矫形骨科学会足踝外科学组（American Orthopedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分和疼痛视觉模拟评分（visual analogue scale,VAS）系统进行功能评价。结果 ：35例（40足）均获得随访,时间12～36(14.35±3.62)个月。HVA、IMA和DMAA分别由术前的（36.32±4.5...     

Scarf osteotomy for hallux valgus repair: the dark side

HYPOTHESIS/PURPOSE: The Scarf osteotomy has gained popularity as treatment of choice in parts of Europe and is based on sound structural principles. The excellent results reported by others could not, however, be reproduced by the author and the results are presented. METHODS: From January 1997 to June 1997 the Scarf osteotomy was selected in 20 consecutive patients (12 female and eight male patients, ages 18 to 60, mean: 41 years) with moderate metatarsus primus varus (IMA 13 to 20 degrees) and hallux valgus deformities (less than 40 degrees). The AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, visual analog scale and patient satisfaction were monitored prior to surgery, six and 12 months post-op. The patients were treated in a short leg cast, non-WB for two weeks followed by four weeks partial WB in a cast shoe. Routine post-bunion rehabilitation followed once the radiological and clinical diagnosis of healing was made. RESULTS: Multiple complications were encountered. The most common was "troughing" of the metatarsal with loss of height. This occurred in seven patients (35%). Other complications include delayed union (5%), rotational malunion (30%), proximal fracture (10%), infection (5%) and early recurrence of deformity in 25%. All 20 patients were available for follow-up at six months, and 19 of 20 at 12 months. The AOFAS score pre-op was a mean of 53. At six months a mean of 54 (19 to 69) and at 12 months 62 (24-100). Forty-five percent (9/20) were unsatisfied at one year and would not recommend the surgery to a friend. CONCLUSIONS/SIGNIFICANCE: The Scarf osteotomy has multiple potential pitfalls and should probably be reserved for moderate bunions in young people with good bone quality. There are multiple potential problems and the salvage of a failed Scarf osteotomy is difficult.     

Scarf osteotomy for hallux valgus—is an Akin osteotomy necessary?

Scarf osteotomy has gained popularity as one of the recommended procedures for moderate to severe hallux valgus. An Akin osteotomy may also allow additional correction but carries its own complications. The aim of this study was to assess the need for Akin osteotomy with a scarf procedure.We reviewed our results of scarf osteotomy with and without Akin in 69 patients with 99 procedures. Sixteen patients (25 feet) had an Akin osteotomy with a scarf procedure. Radiological results were analysed by measuring the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the position of the tibial sesamoid. AOFAS scores were collected prospectively. Patient satisfaction was determined by whether or not they would have the operation again for a similar condition.The mean age of the patients was 48.3 years (range 12–76) with a mean follow-up of 21 months. The mean improvement for the whole group in the IMA was from 15.8 to 7.9, HVA from 37.9 to 16.4 and DMAA from 19 to 9.9 was noted. The position of sesamoids improved from a mean of 5.8 to 2.3. The results were similar in both the groups and no significant difference was noted. AOFAS score improved from a mean of 53.6 preoperatively to 92.5 postoperatively. Three patients in the scarf group needed an Akin osteotomy as a revision procedure.Scarf osteotomy alone may be an effective procedure for moderate to severe hallux valgus. An Akin osteotomy may be indicated if residual hallux valgus is noted during surgery.     

Early outcome of correction of hallux valgus with the Scarf osteotomy

INTRODUCTION: Aim of this study is to analyze complications as well as clinical and radiological results of the scarf osteotomy for the correction of hallux valgus. PATIENTS AND METHODS: Between 1994 and 1998 we performed a scarf osteotomy for the correction of hallux valgus in 45 cases. Indication was a symptomatic hallux valgus with an increased first intermetatarsal angle (IMA). Fixation of the osteotomy was performed with two 2.3 mm mini screws made of titaneum. Mobilisation was allowed with full weight bearing with a fore foot relief orthesis. Clinical results were valued with the fore foot scoring system (ffss). The determination of the IMA and hallux valgus angles (HVA) was performed with weight bearing d.p. radiographs. RESULTS: All osteotomies healed within the first 6 postoperative weeks. Removal of the screws was not necessary in any case. The preoperative ffss was 16.2 points. At the last follow up (16 month after surgery) the average value of the ffss was 59.1 points. Three patients reached a value below 35 points, two of them suffered from a rheumatic disease. Twenty patients assessed the cosmetic result as excellent, 16 as good, 4 as satisfactory and one as poor. The average IMA could be reduced significantly from 20.2 to 10.3 degrees. The HVA could be lowered from 37.5 to 20.9 degrees. In patients with an IMA of more than 20 degrees the HVA could be reduced to 23.1 degrees in contrast to 18.3 in patients with an IMA of less than 20 degrees. DISCUSSION: The scarf osteotomiy is a surgical procedure for the correction of hallux valgus due to increased IMA which is appropriate in patients younger than 50 years and older than 50 years. In cases of IMA more than 20 degrees correction of IMA and HVA was unsatisfactory.     

Scarf截骨治疗躅外翻的短期疗效分析

背景：拇外翻为足踝外科常见病、多发病,目前以各种手术治疗为主,术后效果及复发率有较大差异。目的：探讨Scarf截骨联合其他手术方式治疗中、重度拇外翻的短期疗效。方法：2008年7月至2010年6月,采用Scarf截骨治疗中、重度坶外翻患者33例（41足）,男4例（4足）,女29例（37足）;年龄24-69岁,平均51．7岁。在Scarf截骨的基础上部分患者联合第一跖趾关节骨赘切除、软组织松解及拇趾近节趾骨Akin截骨等手术方式。采用美国足踝外科协会（American Orthopedic FootandAnkle Society,AOFAS）Maryland拇跖趾关节评分系统进行疗效评估。随访时摄足负重位X线片并测量拇外翻角（halluxvalgusangle,HVA）和第一、二跖骨间角（intermetatarsalangle．IMA）。结果：所有患者均获随访,时间12-36个月,平均20．4个月。HVA由术前32．78。矫正至10．18°,IMA由术前11．57。矫正至6．26。。Maryland拇跖趾关节评分：90-100分28足（68．3％）,80-89分11足（26．8％）,70-79分2足（4．9％）,优良率为95．1％（39／41）。结论：Scarf截骨术具有较好的自身稳定性,纠正畸形能力强,愈合快,坚固的内固定可使患者早期下地活动,并发症相对较少,联合其他手术方式是治疗中、重度拇外翻的理想方法。     

Scarf osteotomy in the management of symptomatic adolescent hallux valgus

Purpose  

This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus.     

Scarf versus proximal closing wedge osteotomy in hallux valgus treatment

Aim  The aim of this study was to evaluate the distal metatarsal articular angle as a key factor in choosing between the proximal closing wedge osteotomy and scarf osteotomy. Method  The investigation involved 40 feet: 32 females aged 13–68 in whom 24 unilateral and 8 bilateral operations had been performed from 24 to 63 months previously. Results  There were statistically significant differences between groups in the postoperative hallux valgus angle and in first metatarsal shortening. We found an inverse correlation between the preoperative distal metatarsal articular angle and intermetatarsal angle improvement after proximal closing wedge osteotomy and a positive correlation after scarf osteotomy. Conclusion  This study confirmed the value of distal metatarsal articular angle assessment.