第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻

目的探讨第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻的临床疗效。方法对12例重度拇外翻畸形患者(14足)采用第1跖趾关节融合结合Weil截骨或关节成形术治疗。结果患者均获得随访,时间6~44个月。术后患足外形均得到良好改善,13足拇外翻疼痛及跖痛消失,第2~5跖骨头下顽固性角化症、硬性胼底消失;1足出现第5跖骨外侧转移性跖痛,经垫前足减压垫缓解。术后患者跖趾关节有不同程度僵硬,经主、被动关节锻炼后,足趾活动度均有改善,未影响日常活动,患者步态及穿鞋要求均获得明显改善。末次随访时,患足AOFAS评分85.48分±2.97分,VAS评分2.41分±0.47分,HVA 14.93°±5.35°,IMA 9.68°±1.87°,各项指标均较术前明显改善(P0.01)。结论采用第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻畸形,能明显改善前足外形,缓解前足行走疼痛,改善肢体功能,提高患者生活质量。     

第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻

目的：探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法：回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例（69足）,男8例（11足）,女29例（58足）;年龄67～83(70.03±2.87)岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分（visual analogue scale,VAS）进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会（American Orthopaedic Foot and Ankle Surgery,AOFAS）前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角（hallux valgus angle,HVA）,第1、2跖间角（intermetatarsal angle,IMA）的变化情况。结果：37例（69足）患者获得随访,时间12～48 (22.8±0.6)个月。术后7～10(8.00±1.21)周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA (44.30±2.84)°与...     

背侧入路联合Weil截骨术治疗第2跖趾关节跖板损伤

目的:评价背侧入路联合Weil截骨治疗第2跖趾关节跖板损伤的临床疗效。方法:自2012年6月至2013年12月,采用背侧入路联合Weil截骨治疗第2跖趾关节跖板损伤患者5例8足,平均年龄52岁。术前症状为第2跖趾关节不稳定伴跖痛症。所有患者得到随访,时间6～12个月。采用AOFAS评分及VAS评分评价疗效。结果:术后所有患者第2跖趾关节恢复稳定及跖痛缓解。所有患者VAS评分低于术前,AOFAS评分高于术前。结论:应用背侧入路联合Weil截骨治疗第2跖趾关节跖板损伤可有效缓解跖底疼痛,稳定跖趾关节,降低术后半脱位率及术后关节僵硬发生率低。     

Weil截骨术与Jacopy截骨术治疗应力性跖痛症的临床疗效对比观察

背景：跖痛症是指发生于跖骨头下方的前足疼痛,可由解剖结构异常、病理性或医源性因素诱发。其病变主要是因为前足集中的局部应力负荷反复作用造成。治疗可分为保守治疗与手术治疗,对大部分跖痛症而言,采用保守治疗即可取得较好的疗效,若保守治疗无效,则可采取手术治疗,其目的是恢复前足正常的应力分布。目的：探讨跖骨远端weil截骨术与Jacoby截骨术治疗应力性跖痛症的临床疗效,从而为临床上更加合理有效的治疗跖痛症提供方法和依据。方法：2010年5月至2012年9月,我院收治应力性跖痛症患者65例,其中42例（63足）患者资料完整,得到随访,男8例（13足）,女34例（50足）;年龄39～78岁,平均56-3岁。单侧11例,双侧31例;病变于第2跖骨头下24例,第3跖骨头下ll例,第2、3跖骨头下同时累及7例。合并跖趾关节脱位12例,跽外翻畸形16例,跖间神经瘤5例。所有病例随机分为A、B两组,A组19例（32足）,B组23例（31足）。A组采用跖骨远端Weil截骨术、B组采用Jacoby截骨术治疗,经过平均18个月的随访,对手术前后局部疼痛症状、患者足底应力变化、足部功能改善情况进行比较分析。结果：两种手术前后疼痛缓解均有显著性差异,以Weil截骨组疼痛缓解更明显,但两组间疼痛缓解无明显统计学差异。两组患者手术前后患趾跖骨头下应力峰值明显下降。Weil截骨组,手术前后立位时和足跟抬高时的病变跖骨头下应力分别下降35％和51％;Jacoby截骨组分别下降25％,n45％。根据美国足踝外科协会Maryland跖趾关节百分评分法对两组患者进行评定：优,A组24足（占75％）,B组22足（占71％）;良,A组6足（占18．8％）,B组5足（占16．1％）;可,A组2足（占6．2％）,B组4足（占12．9％）。A组优良率为93．8％,B组为87．1％。结论：对于应力性跖痛症患者,跖骨远端Weil截骨术与Jacoby截骨术治疗均可取得满意确切的效果。但weil截骨术手术操作技巧要求更高,Jacoby截骨术对初学者更易掌握。临床需要根据患者的实际情况及个体需求灵活选择。     

Weil截骨术

Weil截骨术通过对跖骨头、颈部位进行斜行截骨,以实现跖骨短缩。该术式由美国的Weil LS医师于1985年首先提出并将其应用于中央跖痛症(第2～4跖骨)患者,随后由Barouk医师在欧洲推广。与传统的截骨术相比,Weil截骨术具有操作简单、截骨部位接触面积大、断端固定可靠等优点,因此在前足疾患的矫形手术中应用日趋广泛。     

跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位临床疗效分析

目的探讨跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位的临床疗效。方法采用跖骨近端截骨短缩、跖趾关节复位术治疗的跖痛症合并重度跖趾关节脱位65例,共83个跖趾关节,其中第2跖趾关节68个,第3跖趾关节15个。患足均于手术前后拍摄负重正侧位X线片,测量相关指标,并采用ACFAS、VAS评分对手术前后进行临床评估。结果截骨后跖骨平均短缩长度为5.94 mm。术后跖趾骨夹角、跖骨切线角、跖趾关节间隙及跖趾关节活动度等指标较术前均有改善,差异有统计学意义(P<0.05)。ACFAS评分术前为(44.06±7.54)分,术后为(90.43±3.88)分;VAS评分术前为(8.14±0.97)分,术后为(1.14±0.73)分;各评分术后均较术前明显改善,差异有统计学意义(P<0.05)。结论跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位临床疗效确切。     

第4跖趾关节并跖跗关节脱位1例

患者，男，43岁，摔伤致左足背肿痛不能站立约10h，次日来我院就诊。检查：左足背肿胀甚，皮肤呈青紫色，第4跖骨头和基底部压痛明显，触摸第4跖骨头背侧凹陷，跖侧可摸到突起的第4跖骨头，左足诸趾未梢血液循环和感觉正常。X线片示：左足第4跖趾关节并跖附关节脱位，第4跖骨头明显向跖侧内侧移位；     

Ludloff截骨+跖趾关节置换治疗重度拇外翻的临床研究

目的 探讨Ludloff截骨+跖趾关节置换治疗伴有跖趾关节骨性关节病的重度拇外翻的临床效果.方法 选取首都医科大学附属北京友谊医院2013年4月-2015年8月的病例,共120例,术前通过足部负重正位片,测量踇外翻角、跖骨间角、近端关节面固有角,并进行Maryland评分评价患者足部情况,组间进行t检验,两组间术前资料差异无统计学意义,具有可比性.两组诊断均是伴有跖趾关节骨性关节病的重度拇外翻患者进行研究,按照入院顺序随机分为试验组和对照组,每组各60足.试验组采用Ludloff截骨+跖趾关节置换治疗,对照组采取Ludloff截骨+Akin截骨的手术方法治疗.采用视觉模拟评分量表评价患者的疼痛,采用生活质量核心量表以及Maryland足功能评分对两组患者手术前后的疼痛、跖趾关节活动、外观及稳定情况、日常生活质量及体育活动情况,进行统计分析,组间比较采用t检验,手术前后比较采用配对t检验,采用Fisher确切概率法分析两组间并发症的差异.结果 试验组总优良率(91.7％)高于对照组的总优良率(75.0％),差异具有统计学意义(P＜0.05);试验组不良反应发病率(1.7％)低于对照组不良反应发病率(8.3％),但是差异无统计学意义(P＞0.05);试验组治疗后生活质量各维度评分明显高于对照组,差异有统计学意义(P＜0.05);术后试验组的VAS疼痛评分(1.61±0.12)明显低于术后对照组(3.68±0.58),差异有统计学意义(P＜0.05).结论 采用Ludloff截骨+跖趾关节置换治疗伴有跖趾关节骨性关节病的重度拇外翻的临床效果较好、安全性强、创伤小、患者恢复快,有一定的推广和使用价值.     

跖骨头软骨面下弧形截骨改善第二跖趾关节屈曲方向的临床研究

目的 探讨带跖趾关节的第二趾移植再造拇手指过程中,利用跖骨头软骨面下选择性截骨来改善跖趾关节屈曲方向的手术方法和临床疗效. 方法 对21例21指带跖趾关节的第二趾移植再造拇、手指病例,术中在第二跖骨头底部关节囊近侧做截骨口,距跖趾关节面5.0 mm处进入跖骨,弧形截除松质骨,使跖趾关节可以屈曲到90°为止,纵贯或交叉克氏针固定关节,再按常规的再造方法重建动力、神经及血液循环. 结果 本组所有再造指均成活.随访时间6～24个月,其中6例得到长期随访(12 ～ 24个月).再造指的掌指关节被动活动范围65°～85°,平均75°.主动活动范围45°～80°,平均65°.X线片复查显示骨质愈合良好,无关节退性行变表现. 结论 在带跖趾关节的第二趾移植再造拇、手指过程中,采用跖骨头软骨面下选择性截骨的方法能明显增加再造掌指关节主、被动屈伸活动度,是提高再造指掌指关节活动度的较佳方法.     

The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies

Hardly any surgical methods are available for metatarsalgia caused by a dislocated lesser metatarsophalangeal joint (MTP) that do not sacrifice the joint. We reviewed retrospectively the outcome of 60 metatarsal Weil osteotomies for correction of dislocated lesser MTP joints in 31 patients. Between 1995 and 1996, 31 consecutive patients were treated with a Weil osteotomy at 2 institutions. The Weil osteotomy is an oblique osteotomy of the metatarsal neck and shaft, parallel to the ground surface, that controls shortening of the metatarsal by internal fixation with screws or pins. At an average final follow-up of 30 (24-44) months, all patients were interviewed, using a standardized questionnaire based on the AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale. Recurrent or transfer metatarsalgia, formation of callus, mobility and dislocation of the MTP were noted on physical examination. Dorsoplantar and lateral weightbearing radiographs taken preoperatively and at the time of final follow-up were examined for alignment of the metatarsal heads, subluxation or dislocation and for evidence of nonunion, or malunion of the metatarsal osteotomy. We had excellent results in 21 patients (42 osteotomies). A major complication was plantar penetrating hardware in 10 cases (3 screws and 7 pins). We conclude that the Weil osteotomy is a good method for correcting metatarsalgia caused by dislocation of the MTP joint.     

The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: Good outcome in 21 patients with 42 osteotomies

Hardly any surgical methods are available for metatarsalgia caused by a dislocated lesser metatarsophalangeal joint (MTP) that do not sacrifice the joint. We reviewed retrospectively the outcome of 60 metatarsal Weil osteotomies for correction of dislocated lesser MTP joints in 31 patients. Between 1995 and 1996, 31 consecutive patients were treated with a Weil osteotomy at 2 institutions. The Weil osteotomy is an oblique osteotomy of the metatarsal neck and shaft, parallel to the ground surface, that controls shortening of the metatarsal by internal fixation with screws or pins. At an average final follow-up of 30 (24-44) months, all patients were interviewed, using a standardized questionnaire based on the AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale. Recurrent or transfer metatarsalgia, formation of callus, mobility and dislocation of the MTP were noted on physical examination. Dorsoplantar and lateral weightbearing radiographs taken preoperatively and at the time of final follow-up were examined for alignment of the metatarsal heads, subluxation or dislocation and for evidence of nonunion, or malunion of the metatarsal osteotomy. We had excellent results in 21 patients (42 osteotomies). A major complication was plantar penetrating hardware in 10 cases (3 screws and 7 pins). We conclude that the Weil osteotomy is a good method for correcting metatarsalgia caused by dislocation of the MTP joint.     

The Weil osteotomy for the treatment of painful plantar keratoses

Management of painful plantar corns remains challenging. Failure of conservative treatment may necessitate surgical intervention. The aim of this study was to assess the effectiveness of the Weil osteotomy in the treatment of painful plantar corns. A total of 29 patients (33 feet) underwent Weil osteotomy combined with plantar lesion excision of a single metatarsal of either the second, third or fourth metatarsals. These were reviewed post-operatively at an average of 42.4 months. At final review, nine feet (27%) presented with a corn. Four feet (12%) developed transfer metatarsalgia with a total of seven feet (21%) requiring revision surgery. The average metatarsal shortening was 4.5 mm. Requirement for regular clinical lesion reduction fell from an average of 5.6 weeks to 12 weeks (P<0.001) between treatments and the American Orthopaedic Foot And Ankle Society clinical rating scale improved by an average of 48 points (P<0.001). The Weil osteotomy is a moderately effective intervention which should be considered in planning the treatment of intractable plantar corns.     

Modified Weil Osteotomy for the Treatment of Freiberg's Disease

Background

Numerous metatarsal osteotomies have been developed for the treatment of Freiberg''s disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg''s disease.

Methods

From November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg''s disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients'' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg''s disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed.

Results

VAS showed improvement from 6.2 ± 1.4 to 1.4 ± 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 ± 14.9 to 80.4 ± 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 ± 10.1 to 48.3 ± 13.0 degrees at last follow-up (p < 0.0001). According to Smillie''s classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results.

Conclusions

Modified Weil osteotomy is believed to be a useful method for the treatment of Freiberg''s disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.     

Comparative study of the Weil osteotomy with and without fixation

Background

Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head.

Methods

The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system.We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively.

Results

All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15–100) and 75.3 points (from 47 to 100) in each group (P = 0.11).

Conclusions

The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).     

第一跖趾关节痛风石的手术治疗

目的探讨和总结跖趾关节巨大痛风石的治疗方法、疗效分析。方法对12例第一跖趾关节巨大痛风石患者,在综合治疗基础上,行手术治疗,术后长期监控血尿酸。结果本组12例,全部得到随访,随访时间6～24个月,平均13．4个月。关节切口Ⅰ期愈合,仅1例切口出现延迟愈合,占8．3％。术后跖趾关节外观和关节功能满意。结论积极的手术治疗是治疗第一跖趾关节巨大痛风石的有效方法,能减少痛风急性发作的次数,改善足的外观、保护足的功能。     

改良髋臼周围截骨术治疗儿童发育性髋关节脱位

目的 :探讨改良髋臼周围截骨术式治疗儿童发育性髋关节脱位。方法 :采用髋臼周围截骨术联合髋臼加盖术 ,截骨端以楔形骨块充分植骨治疗儿童发育性髋关节脱位 3 7例 47髋。结果 :随访 3 0例 ,3 8髋。随访 1 5～ 5年 ,平均 3 2年。按周永德评定标准 ,优 3 1髋 ,良 6髋 ,可 1髋。结论 :改良髋臼周围截骨术是治疗发育性髋关节脱位较理想的方法     

Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability

Background

Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures.