跖骨截骨术（Mitchell）治疗坶外翻

本院从１９５７年～１９９１年共收治３３３例５９３足外翻畸形患者，其中２４７例４４７足行ｋｅｌｌｅｒ术，占７５．３８％，自１９７９～１９９１年行Ｍｉｔｃｈｅｌｌ术５１例９１足，占１５．３５％，其它手术占８％。本文重点讨论了外翻的病因，介绍Ｍｉｔｃｈｅｌｌ手术方法、手术适应症、手术中注意事项。随诊４个月至６年，结果优良率达８４％，（其中１０足未随诊），本文将此术式介绍给年龄较轻，跖趾关节骨性关节炎不明显，畸形不严重，但疼痛的患者。此外讨论了外翻角度与跖间角之间的关系。     

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。     

Relationship between Foot Width Reduction and Clinical Outcomes after Chevron Osteotomy for Hallux Valgus Deformity

BackgroundRadiological correction of hallux valgus deformity is the objective of operation and related to successful outcomes. Nonetheless, footwear problems related to foot width can also affect the clinical outcome. Few studies have analyzed changes in foot width, and data on clinical outcomes after correction of hallux valgus deformity are scarce.MethodsThe study included 159 cases with symptomatic hallux valgus deformity who underwent proximal or distal chevron metatarsal osteotomy and were followed up for a mean of 32.8 months. Radiologically, the hallux valgus angle, intermetatarsal angle, first metatarsal head width, bony foot width, and soft-tissue foot width were analyzed. Clinically, the visual analog scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score were evaluated.ResultsThe preoperative hallux valgus was corrected radiologically at the last follow-up. The bony foot width was reduced by 9.4%, and the soft-tissue foot width was reduced by 7.1% (p < 0.001 for all). The mean AOFAS score improved from 51.2 preoperatively to 89.4 at the final follow-up (p < 0.001). In multiple regression, the perioperative changes of bony foot width were associated with final AOFAS score (p = 0.029).ConclusionsChevron osteotomy performed for hallux valgus deformity resulted in satisfactory radiological and clinical outcomes. Perioperative changes in bony foot width showed a significant correlation with AOFAS score. Therefore, to correct hallux valgus deformity, it is necessary to correct known radiological indicators sufficiently and make efforts simultaneously to reduce the foot width optimally.     

Chevron手术治疗外翻畸形

为寻求矫正外翻畸形的理想手术方法，自１９９０年以来作者采用Ｃｈｅｖｒｏｎ手术治疗１２例１８足。经１～７年随访，结果：优１５足（８３％），良２足（１１％），差１足（６％），优良率９４％。畸形矫正：趾外翻角术前３５°～４０°，术后５°～９°；第一跖骨间角术前１５°～２０°，术后５°～１０°；跖骨远侧关节角术前均＞１５°，术后均＜１５°；前足宽度术前６０～７０ｍｍ，术后５５～６５ｍｍ。无跖骨头无菌性坏死和骨不连等并发症。表明该手术有手术简单，截骨端嵌插稳定，畸形矫正满意，并发症少和行走时间早，恢复快等优点     

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient’s point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients’ daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations.All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS.For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72–84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58–100 versus 73–89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle.In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details.     

Consensus on Surgical Management of Hallux Valgus from China

Hallux valgus deformity is one of the most common diseases in foot and ankle surgery. Satisfactory outcomes tend to be achieved only through operative correction. However, selection of the optimal surgical strategy is always a controversial topic, and the rate of dissatisfied patients postoperativelyis still very high. It is well known that there are various pathological changes in hallux valgus deformity, so it is impossible to use one specific procedure to solve all the problems. It requires a careful preoperative physical examination and radiographic assessment to choose the best operation for each kind of deformity according to each pathalogical change, combined with good postoperative dressing, immobilization and proper rehabilitation and follow up, to improve surgical outcomes and reduce postoperative rate of complication and dissatisfaction. In order to achieve these goals, a Consensus on the Operative Correction of Hallux Valgus has been developed by the Foot and Ankle Working Committee, Orthopaedic Branch, Chinese Association of Orthopaedic Surgeons. Foot and ankle surgeons following this consensus must be fully aware of their patients' desires, carefully evaluate different pathological processes and clinical symptoms and be skilled in various procedures. Then these procedures can be easily selected, converted and combined based on preoperative plans and intraoperative conditions.     

跖趾关系与踇外翻

目的：探讨外翻的病因、发病机制,指导手术治疗。方法：选取６３足前后位Ｘ线片,其中,正常人３７足,外翻病人２６足,测量并统计分析以下参数：ＭＰＪＣ、ＭＰＡＤ、ＤＡＳＡ、ＰＡＳＡ、ＨＡＡ、ＩＭＡ。结果：外翻病人有明显的ＭＰＪＣ、ＭＰＡＤ、ＰＡＳＡ增大。ＨＡＡ、ＩＭＡ、ＰＡＳＡ之间并不存在统计学上的联系。结论：外翻的病理可以分为３型：Ⅰ型,ＩＭＡ增大为主型;Ⅱ型,ＰＡＳＡ增大为主型;Ⅲ型,混合型。Ⅰ型宜采用矫正ＩＭＡ的术式;Ⅱ型宜采用矫正ＰＡＳＡ的术式,不宜采用矫正ＩＭＡ的术式;Ⅲ型应联合应用以上２种术式。