Akin截骨联合第1跖骨截骨治疗拇外翻的疗效

目的 探讨Akin截骨联合第1跖骨截骨治疗拇外翻的疗效.方法 采用Akin截骨联合第1跖骨截骨治疗27例拇外翻患者(27足):Akin截骨联合Chevron截骨19例,Akin截骨联合Scarf截骨6例,Akin截骨联合Juvara截骨2例.比较术前及末次随访时的第1、2跖骨间夹角(IMA)与拇外翻角(HVA)的变化....     

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.     

The oblique proximal phalangeal osteotomy in the correction of hallux valgus

An oblique proximal phalangeal osteotomy is introduced as an alternative to the Akin procedure for the treatment of hallux valgus. It consists of a single oblique osteotomy directed from proximal-dorsal to plantar-distal. A retrospective review of 32 patients who underwent 36 oblique proximal osteotomies is presented. The mean follow-up was 11 months (range, 3 to 21 months). Pre- and postoperative radiographic measurements of the distal articular set angles showed an average correction angle of 12 degrees (range, 7 degrees to 22 degrees; SD = 2.99). Mean range of first metatarsophalangeal joint motion was 82% of the preoperative value when combined with distal metatarsal osteotomy, and 87% of the preoperative value without a distal metatarsal osteotomy. Time to clinical and radiographic healing averaged 5 weeks (range, 4 to 8 weeks). The average amount of phalangeal shortening was 1 mm (range, 0 to 2 mm). There were no delayed or nonunions. Subjective assessment conducted by retrospective review of 19 patients at 6 months postoperatively showed that 17 were completely satisfied (90%), 1 was satisfied (5%), and 1 fairly satisfied (5%). Nineteen would have the surgery again (1 with reservations). Eighteen were very satisfied with appearance and 1 was improved. Fourteen returned to shoe gear at weeks 6 to 8, and 5 returned at weeks 8 to 12. Eighteen were satisfied with pain relief and 1 was improved. The study indicates that the oblique proximal phalangeal osteotomy is an effective, reliable, and technically simple procedure for correction of deformities of the proximal phalanx. The advantages include minimal shortening, ease of adjustability, and a construct conducive to rigid fixation.     

第一跖列三平面截骨联合其余跖骨基底截骨治疗中重度跖内收型■外翻的早期疗效

目的探讨第1跖列三平面截骨联合其余跖骨基底截骨治疗中重度跖内收型[足母]外翻的早期疗效。方法2012年2月-2016年9月,收治10例(12足)中重度跖内收型[足母]外翻患者。男1例(2足),女9例(10足);年龄21~55岁,平均34.5岁。病程3~10年,平均5.8年。根据改良Sgarlato测量法对跖内收分度:中度4足、重度8足。术前美国矫形足踝协会(AOFAS)评分为(46.4±9.3)分;跖内收角(metatarsus adductus angle,MAA)为(25.41±3.66)°,[足母]外翻角(hallux valgus angle,HVA)为(41.42±9.67)°,第1-2跖骨间角(first-second intermetatarsal angle,1-2IMA)为(10.72±2.26)°。采用第1跖列三平面截骨联合其余跖骨基底截骨以及外侧软组织松解术治疗。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18~24个月,平均21.4个月。1例(1足)术后出现转移性跖痛,对症处理后症状消失。X线片复查示截骨部位均愈合,愈合时间为2.4~3.2个月,平均2.8个月。末次随访时,MAA为(8.42±0.71)°、HVA为(13.29±1.03)°、1-2IMA为(4.41±0.48)°,AOFAS评分为(89.8±5.9)分,均较术前明显改善(P<0.05)。结论第1跖列三平面截骨联合其余跖骨基底截骨治疗中重度跖内收型[足母]外翻,可获得较好早期疗效。     

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。     

第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻

目的:探讨第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻的临床疗效。方法:2008年7月～2010年7月对21例重度拇外翻患者采用第一跖骨近端斜楔形截骨,同时对外侧关节囊松解、内侧关节囊紧缩、拇内收肌腱部分切断治疗。测量患足负重X线,采用美国足踝外科协会Maryl and的评分方法对患足进行手术前后评定。结果:本组患者21例,术后随访6～24个月,无截骨不愈合及延迟愈合现象。23足无疼痛,1足偶有轻微疼痛。术后Mar yl and评分:90～100分19足,80～89分4足,70～79分1足,优良率95%。结论:第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻效果可靠,可以推广。     

改良Scarf截骨术治疗拇外翻的临床疗效

目的探讨改良Scarf截骨术治疗拇外翻的临床疗效。方法应用改良Scarf截骨术治疗拇外翻患者68例(92足),比较手术前后拇外翻角(HVA)、第1、2跖骨间角(IMA)及远端关节面固有角(DMAA)的变化。末次随访时,采用AOFAS评分标准评价疗效。结果68例患者均获得随访,时间9~12个月。末次随访时,HVA、IMA、DMAA均较术前显著减小(P<0.01),AOFAS评分较术前显著升高(P<0.01),疗效优、良、可分别为82、5、5足,治疗优良率为94.6%。结论改良Scarf截骨术是矫正拇外翻畸形的可靠技术,纠正畸形效果满意,能有效缓解疼痛。     

改良Austin手术治疗(足母)外翻34例62足

[目的]探讨改良Austin手术治疗外翻的手术适应证、手术方法和疗效。[方法]自1998年10月～2006年4月采用改良Austin手术治疗外翻患者34例62足,男13例22足,女21例40足;年龄32～67岁,平均43岁。术前、术后2周、随访时分别摄负重位X线片,测量外翻角(HVA)、第1、2跖骨间角(IMA)、近端关节固定角(PASA)、远端关节固定角(DASA),并观察其变化和测量角度数据进行对比分析。手术方法根据患者术前症状和测量角度个体化选择Austin手术改良式即chevron-gerbert或chevron-youngswick截骨术。[结果]全部获得随访,随访时间1～8年,平均3.6年;患者外翻角(HVA)术前为33.50°±1.02°,术后为13.6°±0.826°;第1、2跖骨间角(IMA)术前为16.0°±0.837°,术后为8.6°±1.078°;根据美国足与踝关节协会AOFAS制定的足趾功能评分标准评价。AOFAS评分术前为(44.8±5.7)分,术后为(87.6±4.2)分。优46足,良10足,可5足,差1足,优良率90.3%。[结论]改良Austin手术是治疗外翻畸形的一种操作简单、疗效可靠的手术方法。尤其更适合矫正PA-SA增大的重度外翻。对年龄较轻的轻、中度外翻患者手术应尽量不必干扰内收肌和籽骨也可达到矫形的目的。     

Ludloff截骨治疗拇外翻疗效观察

<正>2010年1月~2013年8月,我科收治36例中、重度拇外翻患者,均采用Ludloff截骨配合软组织手术,疗效满意,报道如下。1材料与方法1.1病例资料本组36例,男2例,女34例,年龄40~65岁。术前X线检查:拇外翻角25.8°~38.6°,第1、2跖骨间夹角15°~21.5°。跖趾关节无退行性改变。内侧跖楔关节无明显的不稳定。1.2治疗方法采用踝神经阻滞麻醉。于第1、2跖骨头趾蹼背面近侧2~3 cm     

McBride手术联合第1、2跖骨近端截骨治疗拇外翻

目的探讨McBride手术联合第1、2跖骨近端截骨治疗拇外翻的疗效。方法在McBride手术基础上,行第1跖骨近端的楔形外翻截骨和第2跖骨近端截骨,第1跖骨截骨处行微型钢板内固定,第2跖骨截骨处不做固定。术后石膏固定4周后即开始逐渐负重功能锻炼。结果26例均获随访,时间12～48个月。40足中优28足,良10足,差2足,优良率95%。与术前比较,拇外翻角平均矫正16.3&#176;&#177;2.2&#176;,第1、2跖骨间夹角平均矫正4.2&#176;&#177;1.8&#176;。无截骨处愈合不良、拇内翻、感染。结论McBride手术重建了足拇指的软组织力量平衡,第1、2跖骨截骨改善了第1跖骨的正常负重、缓解了第2跖骨头的压力,恢复足横弓,是治疗拇外翻的较好术式。     

Comparison of modified Mitchell and Chevron osteotomies for hallux valgus

BackgroundGood clinical and radiological outcomes in mild-moderate hallux valgus (HV) can be achieved with Chevron osteotomy (CO) and modified-Mitchell osteotomy (MMO). The main goal of the present study was to compare the clinical and radiological outcomes after CO and MMO in HV.MethodsThe study included 45 patients, comprising 40 females with a mean follow-up of 87.5 ± 27.8 months. The outcome measurements of metatarsal length (MT1), HV angle (HVA), intermetatarsal angle (IMA), clinical outcomes, and metatarsalgia were evaluated pre- and postoperatively.ResultsNo significant difference was determined between the MMO and CO groups in respect of metatarsalgia and AOFAS scores. The CO resulted in a significantly larger decrease in the MT1. The mean HVA and IMA correction was significantly greater after MMO than after CO.ConclusionSince MMO may prevent MT1 shortening, which is a typical problem in the Mitchell osteotomy, MMO may be preferred over CO in patients with preoperative shortened first metatarsal.     

(足母)外翻的手术治疗

(足母)外翻是一种常见的前足疾病,发病率较高,多见于女性,常随年龄增长而呈加重趋势,由于畸形和疼痛,常需手术治疗.(足母)外翻的手术治疗早在18世纪末已广泛兴起,随着各种术式的广泛开展及对其效果的追踪评价,大多数手术方式由于弊大于利被淘汰,而一些术式被证实有效,且经过不断改良与完善,已融入现代治疗方法中,手术方式主要包括软组织修复手术、截骨术、关节成形术及关节融合术,手术方法的合理选择是保证治疗效果的关键.     

Akin截骨术在拇外翻手术应用的探讨

背景：Akin截骨术能够纠正拇外翻手术中残留拇趾畸形但也存在并发症,总结探讨在拇外翻手术时联合应用Akin截骨治疗拇外翻的临床疗效并探讨使用指征。 方法：总结分析2006年10月至2010年10月,在拇外翻手术时联合应用Akin截骨术48足,软组织手术加Akin截骨术6足,chevon截骨术加Akin截骨术29足,跖骨基底截骨加Akin截骨术8足,第一跖楔关节融合加Akin截骨术5足。 结果：所有病例均获得随访,随访时间6个月至5年,平均30．3个月,未见拇外翻复发病例。术前拇外翻角为37．2°±8．9°,IMA为16．5°±6．7°;术后拇外翻角为13±6．8°,IMA为8．9°．±4．5°。术前AOFAS评分为（43±10．5）分,术后为（84±7．8）分,具有统计学意义。 结论：在拇外翻手术时,根据趾骨畸形情况联合应用Akin截骨术可以降低拇外翻手术复发率,临床效果确切,但需要严格掌握手术适应证。     

第1跖骨远端改良Chevron截骨治疗[足母]外翻

背景：[足母]外翻的手术治疗方式众多,传统Chevron有一定的手术操作局限性。目的：观察采用第1跖骨远端改良Chevron截骨治疗轻中度[足母]外翻的临床治疗效果。方法：2011年12月至2012年10月采用Chevron截骨对22例患者（28足）进行[足母]外翻矫正,记录患者术前、术后美国足踝外科医师协会评分（AOFAS）,术前、术后测量第1、2跖骨间角（IMA）和躅外翻角（HVA）变化以评估矫正程度,采用AOFAS前足评分和生活功能评分简表（SF．36）评估功能恢复情况。结果：22名患者术后平均随访时间13．36个月（8～18个月）,术前患者平均AOFAS评分（43．59±6．85）分,术后平均85．55±5．66分。术前患者平均SF．36量表评分（45．42±5．54）分,术后平均（83．23±8．81）分,两者术前、术后比较有显著统计学差异（P〈0．01）。IMA术前13．80°±1．67°,术后6．70°±1．51°（P〈0．01）;HVA术前平均29．30°±2．78°,术后7．47°±2．82。（P〈0．01）。结论：第1跖骨远端改良Chevron截骨治疗轻中度蹰外翻手术操作技术简便,临床效果满意。     

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。     

Metatarsal and phalangeal double osteotomy of the first shaft in the treatment of hallux valgus

Numerous surgical techniques have been proposed for the surgical treatment of hallux valgus. Some of them only concern soft tissues; others combine a surgery on the soft tissues with a procedure on the bone structures. The technique we present combines a basimetatarsal valgization by subtractive external osteotomy with a wide metatarso-phalangeal freeing. The basimetatarsal osteotomy allows to correct the deformities in the three planes of space. The basi phalangeal osteotomy is not systematic but is proposed in case of severe hallux valgus, superior to 45° or in case of hallomegalia (gigantism of hallux).     

拇外翻截骨矫形绷带外固定的疗效

目的分析微创截骨矫形后绷带外固定拇外翻治疗的效果。方法对519例(961足)拇外翻患者微创截骨矫形术后采用"8"字绷带缠绕外固定。结果患者均获得随访,时间3~36个月。截骨均愈合,时间为12~20周。无骨折不愈合或假关节形成者。结论绷带外固定可以达到维持复位后的固定要求,使骨折愈合;与传统固定方法比较该方法具有方便、灵活、痛苦小且可早期功能锻炼等优点,值得在一些特殊部位骨折固定中应用。     

Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus

BackgroundRecurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described.Methods32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%).ResultsPatients were assessed with a mean follow-up of 9.8 ± 4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9 ± 17.8 points to 85.2 ± 14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1 ± 9.1 to 9.7 ± 5.4°, the intermetatarsal angle decreased from 11.5 ± 4.5 to 6.7 ± 4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case).ConclusionsPercutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery.Levels of evidence: IV, Retrospective Case Series.     

A radiographic study of the relationship between metatarsus adductus and hallux valgus

The relationship between metatarsus adductus and hallux valgus was evaluated on 100 dorsoplantar weight-bearing radiographs. The metatarsus adductus angle varied positively with the degree of hallux valgus. By using measures of correlation, a significant linear association was found for women (r =.53, P <.001) and men (r =.48, P <.001). The relationship was strongest in women when all cases of abnormal metatarsus adductus (>24 degrees ) were associated with abnormal degrees of hallux valgus (>15 degrees ). This relationship was different in men in that abnormal metatarsus adductus angles were not always associated with abnormal hallux valgus angles. With male and female data combined, the prevalence of metatarsus adductus was 55% in subjects with hallux valgus deformity compared with 19% in subjects without hallux valgus. A Chi(2) test showed this to be a significant difference in the distribution of the data (P =.002). The data of this study suggests that there may be a clinical association between metatarsus adductus and hallux valgus. The need to further evaluate the role of metatarsus adductus angle in hallux valgus surgery is emphasized.     

Scarf versus long chevron osteotomies for the treatment of hallux valgus: A prospective randomized controlled study

BackgroundThe aim of this study is to compare scarf osteotomy and long chevron osteotomy in treatment of hallux valgus deformity regarding operative time, power of correction and complications.DesignA prospective randomized controlled comparative trial.Methods48 cases with hallux valgus were divided randomly in 2 groups (21 treated by scarf and 22 treated by long chevron osteotomy and 5 were missed during follow up), average age 36 years, follow up time was average of 25.9 months. Patients were assessed clinically, radiologically, and functional scoring system of American College of Foot and ankle Surgeons (ACFAS)was used both pre and postoperatively.ResultsOperative time was 69 min in scarf group compared to 63 min to long chevron group, radiological correction showed no statistically significant difference between both groups while functional improvement in ACFAS score was in favour of long chevron group 69.1% compared to scarf group 57.5%ConclusionsBoth osteotomies possess almost identical corrective power of the IMA (intermetatarsal angle) and similar clinical outcomes with slightly shorter operative time and subjective technical simplicity for the long chevron osteotomy.