第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻

目的总结第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻的临床疗效。方法采用第1跖趾关节融合术矫正18例老年拇外翻患者(20足),并对第2～5趾畸形行跖趾关节成形术,比较术前及末次随访时拇外翻角(HVA)和第1、2跖骨间角(IMA),应用AOFAS评分系统评价临床疗效。结果患者均获得随访,时间9～24个月。末次随访时,矫形足负重正、侧位X线片显示HVA和IMA均较术前显著减小(P 0. 001);根据AOFAS评分标准评价临床疗效:优1足,良17足,可2足,治疗优良率为18/20。结论第1跖趾关节融合术联合跖趾关节成形术可有效矫正老年拇外翻前足畸形,减轻疼痛,降低术后前足疼痛的复发率。     

侧副韧带和跖板对跖趾关节屈曲功能的影响

目的探讨侧副韧带、跖板对跖趾关节屈曲功能的影响. 方法取成人尸体第2～4足趾,共24趾.按切断双侧侧副韧带和跖板的不同顺序均分为A、B两组(n=12),A组先切断双侧侧副韧带,再切断跖板薄弱部分,B组按相反顺序切断,观察不同顺序切断前后相同负荷下跖趾关节屈曲角度的变化.并于1994年5月～2000年7月,应用第2足趾游离跖趾关节复合组织移植重建第2和第3掌指关节11例,其中2例行跖板切除术,另9例行跖板 双侧侧副韧带切除术. 结果 A组,术前跖趾关节屈曲角度为37.30±5.42°,切断双侧侧副韧带后屈曲角度增加11.29±2.36°,达48.60±2.98°,与切断前比较差异有统计学意义(P<0.01);再次切断跖板后,屈曲角度增加5.30±1.59°,达53.35±2.76°,与切断前比较差异有统计学意义(P<0.01).B组,术前跖趾关节屈曲角度为34.59±5.32°,切断跖板后屈曲角度增加6.29±2.98°,达40.89±2.36°,与切断前比较差异有统计学意义(P<0.01);再次切断双侧侧副韧带后,屈曲角度增加9.71±1.94°,达50.60±2.01°,与切断前比较差异有统计学意义(P<0.01).切断双侧侧副韧带与切断跖板比较,前者更能增加跖趾关节的屈曲角度(P<0.01),二者切断的先后顺序对总屈曲角度改变影响无统计学意义(P>0.05).临床应用后随访显示,仅切断跖板者经2个月随访,屈曲角度为15～45°;切断跖板 双侧侧副韧带者经26.3个月随访,屈曲角度为10.3～58.4°. 结论切断双侧侧副韧带及跖板可增加跖趾关节屈曲角度.     

第一跖趾关节融合术治疗拇外翻的临床疗效

目的 探讨应用交叉中空加压螺钉联合背侧解剖接骨板的第一跖趾关节融合术治疗中重度拇外翻伴骨质疏松患者的临床疗效.方法 自2017年5月～2019年4月收集了46例中重度拇外翻伴骨质疏松患者,年龄65～73岁.观察患者的融合率情况以及术后相关并发症的发生率,分析比较了术前和末次随访时的拇外翻角(HVA)、第一二跖骨间角(I...     

第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎

目的 探讨第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎的临床疗效.方法 2016 年6 月至2018 年9 月北京中医药大学第三附属医院采用第 1 跖趾关节融合术治疗中重度足拇外翻合并第 1 跖趾关节炎患者26 例.手术前后于足负重位X线片上测量足拇外翻角(HVA)和第1 、2 跖骨间角(IMA),采用疼...     

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...     

重塑第一跖趾关节骨形态治疗(足母)外翻

目的评价Keller手术治疗外翻术中重塑第1跖趾关节骨形态的生理活动解剖结构变化。方法2004年4月～2006年11月,采用Keller手术术中重塑第1跖趾关节面骨形态方法治疗外翻11例22足。男3例,女8例;年龄51～73岁。跖趾关节面分型采用Piggot法:型偏斜型17足,型半脱位型5足。外翻角(hallux valgus angle,HVA)24～49°,平均37°;第1跖间角(intermetatarsal angle,IMA)角9.0～13.5°,平均11.5°。结果术后11例22足均获随访6～30个月,平均14个月。参照朱丽华等评定标准:优18足,良3足,差1足。X线片示,14足形成第1跖趾杵臼样假关节,8足假关节面部分咬合。术后HVA7～16°,平均11°;IMA9.0～13.5°,平均11.5°。术后跖趾关节面Piggot法分型:型适合型12足,型偏斜型10足。结论Keller手术中重塑第1跖趾关节骨形态对外翻术后HAV的纠正及症状改善,及关节稳定性有良好改善,减少了术后肌力不足的发生。     

关节镜下跖趾关节成形术治疗跖趾关节炎

目的报道关节镜下跖趾关节成形术治疗跖趾关节炎的临床效果。方法采用关节镜下跖趾关节成形术治疗12例晚期跖趾关节炎。在局部麻醉下手术,分别于跖趾关节两侧建立关节镜入路和器械入路。在镜下切除跖骨头周围的骨赘及炎性滑膜组织,然后截除近节趾骨1/3左右,部分病例楔形切除部分跖骨头背侧关节面,以改善背伸活动度。结果术后随访12～28个月,4例完全没有疼痛,8例偶尔有轻度疼痛感觉。结论关节镜下跖趾关节成形术治疗晚期跖趾关节炎是可行的,符合微创的手术原则,具有很好的安全性和有效性。     

关节镜下跖趾关节成形术患者的术后护理

对36例跖趾关节炎患者在关节镜下行跖趾关节成形术,手术顺利,未见伤口不愈、感染等并发症,平均住院4.2d。术后随访12～32个月,平均19.4个月,13例行走时完全无疼痛,23例偶尔有轻度疼痛,但能接受;跖趾关节活动度改善明显。提出术后做好切口护理,保证切口如期愈合;早期加强康复训练,避免跖趾关节粘连,增加关节的活动度;出院后加强训练指导,最大限度改善患趾功能,可促进患者恢复正常的生活状态。     

人工跖趾关节置换术临床应用初步报告

目的探讨人工跖趾关节置换术治疗跖趾关节骨性关节炎、类风湿性关节炎、!僵硬及跖骨头缺血性坏死的近期疗效。方法2002年3月至2005年3月,应用带金属垫圈的Swanson可屈曲铰链式趾关节假体实施人工跖趾关节置换手术共30例47趾,男11例16趾,女19例31趾;年龄33￣77岁,平均62.5岁;双侧15例31趾。类风湿性关节炎7趾,!僵硬5趾,!外翻畸形伴严重骨性关节炎21趾,第二跖骨头坏死6趾,跖趾关节陈旧性脱位6趾,!外翻术后2趾。第一跖趾关节33趾,第二跖趾关节11趾,第三跖趾关节2趾,第四跖趾关节1趾。2例患者(4趾),第一、二跖骨间角为19°￣20°,平均为19.5°,同时行第一跖骨基底截骨,Biofix可吸收拉力螺钉内固定术。另2例类风湿性关节炎患者(3趾),同时行第二至五跖骨头切除术。采用美国足踝外科协会Maryland跖趾关节百分评分系统,对疼痛、功能、客观体征进行评分。结果29例(46趾)获得随访,随访时间3￣36个月,平均26.5个月。Maryland评分术前为55￣82分,平均72分;术后为67￣96分,平均91分。优41趾(89.13%),良2趾(4.35%),可2趾(4.35%),差1趾(2.17%),手术优良率为93.48%。术后发生伤口延迟愈合2趾,假体脱位1趾,反应性滑膜炎1趾。除假体脱位1趾采用手术取出假体外,其余3趾均保守治疗,效果满意。结论人工跖趾关节置换术治疗严重的跖趾关节骨性关节炎、类风湿性关节炎、跖趾关节陈旧性脱位、!僵硬及跖骨头缺血性坏死的近期疗效较好,优良率高。     

Single-strand ligament reconstruction of the medial collateral ligament restores valgus elbow stability

The purpose of this study was to determine the contribution of the central portion of the anterior bundle of the medial collateral ligament (MCL) to elbow stability and to evaluate the effectiveness of a single-strand MCL reconstruction in restoring elbow stability. Testing of 11 fresh-frozen upper extremities was first performed on the intact elbow and then with the capsule, flexor-pronator muscle group, posterior bundle, anterior or posterior band, and central band cut sequentially. Next, a single-strand reconstruction of the MCL was performed. The elbow was moved passively through a full arc of flexion in both varus and valgus gravity-loaded positions. Ulnar movement with respect to the humerus was analyzed by means of an electromagnetic tracking system. Maximum varus-valgus laxity throughout the arc of supinated flexion and pronated flexion was 6.6 degree plus minus 2.4 degree and 7.4 degree plus minus 2.0 degree, respectively, for the intact specimen, 34.2 degree plus minus 5.6 degree and 37.7 degree plus minus 11.8 degree for the specimen with all of the medial valgus elbow stabilizers cut, and 9.0 degree plus minus 2.5 degree and 10.5 degree plus minus 2.7 degree for the reconstructed specimen. Maximum varus-valgus laxity was not significantly different among any of the sectioning sequences until the central band was cut (P <.0001). There was no significant difference in maximum varus-valgus laxity between the intact and reconstructed elbows (P <.05). Our results demonstrate that the central band is an important valgus stabilizer of the elbow and that a simplified single-strand reconstruction is able to restore stability to the MCL-deficient elbow.     

Technical tip: Reconstruction of medial collateral ligament in correction of hallux valgus deformity with primary medial collateral ligamentous insufficiency

In cases of hallux valgus deformity with primary medial collateral ligamentous insufficiency, there will be an abnormal hallux valgus angle with relatively normal intermetatarsal angle and sesamoid positions. Metatarsal osteotomies may not be effective to correct the deformity. Plication of the attenuated medial capsule may not be strong enough to provide long lasting correction of the hallux valgus deformity. We describe a minimally invasive technique of reconstruction of the medial collateral ligament by means of extensor hallucis brevis tendon graft. This can provide a stronger medial constraint to prevent recurrence of hallux valgus deformity.     

Traumatic hallux valgus following rupture of the medial collateral ligament of the first metatarsophalangeal joint: a case report.

Metatarsophalangealjoint injuries of the great toe are receiving increasing attention in athletes. Significant disability and long-term morbidity can result from these focal injuries. The entity known as turf-toe is widely recognized. Rupture of the medial collateral ligament of the first metatarsophalangeal joint is less common. A case of traumatic rupture of the medial collateral ligament in the great toe of a soccer player, which progressed to hallux valgus deformity, is presented.     

Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability

Both the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) are reported to prevent valgus instability of the knee. In this study, the anatomical mechanisms by which these ligaments prevent valgus instability were experimentally investigated. The valgus rotation angle and the magnitude of the medial joint space opening were measured in six cadaveric knees, using biplanar photography before and after the MCL and/or the ACL were severed. A significant increase in the valgus rotation angle and a large medial joint space opening were observed when the MCL was severed. An increase in the valgus rotation angle was also observed when the ACL was severed, but only a small medial joint space opening was present. The increase in the valgus rotation angle after ACL severance was nearly parallel to the increase in the internal rotation of the tibia. Thus, we concluded that both ligaments function to prevent valgus instability, but that the anatomical reasons for their function are different. The MCL prevents valgus instability by stopping an opening in the medial joint space. The ACL, on the other hand, prevents the internal rotation of the tibia. When the ACL is severed, the internal rotation increases, and causes the valgus rotation angle to also increase, despite the presence of only a small medial joint space opening. Received: May 16, 2000 / Accepted: August 3, 2000     

Strain in the human medial collateral ligament during valgus loading of the knee

The medial collateral ligament is one of the most frequently injured ligaments in the knee. Although the medial collateral ligament is known to provide a primary restraint to valgus and external rotations, details regarding its precise mechanical function are unknown. In this study, strain in the medial collateral ligament of eight knees from male cadavers was measured during valgus loading. A material testing machine was used to apply 10 cycles of varus and valgus rotation to limits of +/- 10.0 N-m at flexion angles of 0 degrees, 30 degrees, 60 degrees, and 90 degrees. A three-dimensional motion analysis system measured local tissue strain on the medial collateral ligament surface within 12 regions encompassing nearly the entire medial collateral ligament surface. Results indicated that strain is significantly different in different regions over the surface of the medial collateral ligament and that this distribution of strain changes with flexion angle and with the application of a valgus torque. Strain in the posterior and central portions of the medial collateral ligament generally decreased with increasing flexion angle, whereas strain in the anterior fibers remained relatively constant with changes in flexion angle. The highest strains in the medial collateral ligament were found at full extension on the posterior side of the medial collateral ligament near the femoral insertion. These data support clinical findings that suggest the femoral insertion is the most common location for medial collateral ligament injuries.     

Single allograft medial collateral ligament and posterior oblique ligament reconstruction: a technique to improve valgus and rotational stability

We present a novel and simple method for single hamstring allograft MCL and PMC reconstruction, which can improve both joint valgus and external rotational stability and maximize utilization of allograft. All patients received arthroscopic evaluation through inferomedial and inferolateral knee incisions to ascertain whether there were intra-articular injuries. An 8-cm-length longitudinal incision was made from 1 cm above adductor tubercle to 5-cm proximal medial tibia joint line. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm below the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm below the medial tibia joint line. A 5- or 6-mm reamer was used to drill the tibia tunnel along with guide pin, and a 6 or 7 mm drill was used to drill the femur tunnel to a depth of 25 or 30 mm until the proximal adductor tubercle. The allograft was harvested from tibia and placed into the tunnel and fixed with absorbable interference screw. All patients performed active rehabilitation exercises after the operation periodically.     

A biomechanical study of stability of the elbow to valgus stress before and after reconstruction of the medial collateral ligament

The purpose of this study was to assess the stability of the elbow to valgus loads after reconstruction of the anterior bundle of the medial collateral ligament (MCL). The MCL in 14 human cadaveric elbows was exposed with a muscle-splitting approach. Each sample was secured in a materials test frame,5 N-m valgus moments were applied in 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion, and baseline stability was measured. This sequence was performed after the anterior bundle was sectioned and again after ligamentous reconstruction was done with the Jobe technique. At 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion, reconstruction reproduced an average of 99%, 102%, 97%, and 89%, respectively, of the stability of the intact ligament. The only significant difference between intact and reconstructed samples was at 120 degrees of flexion (P <.05). We concluded that this procedure reliably restores stability to a ruptured MCL throughout the flexion arc in the immediate postoperative period.     

第一跖楔关节融合治疗(足母)外翻合并第一跖楔关节不稳

目的探讨第一跖楔关节融合重建足横弓治疗外翻合并第一跖楔关节不稳的疗效。方法2003年1月至2005年6月,手术治疗合并第一跖楔关节过度活动、足横弓塌陷的外翻患者23例32足,均为女性;年龄46～72岁,平均(60.3±9.3)岁。第一跖骨头下压、外移及旋后并与失稳的第一跖楔关节融合,融合关节采用AO“T”形钢板固定。外翻畸形采用改良McBride软组织手术矫形。术后石膏固定6周,随后部分负重2周。结果20例患者28足获得完整随访,随访时间6～22个月,平均13.3个月。X线片显示第一跖楔关节均获得良好融合。外翻角从术前的平均51°±12°减小到术后的平均22°±6°;第一、二跖骨间角从术前的平均15°±5°减小到术后的平均9°±4°。患者主观评价,优15足,良9足,可4足,优良率为85.7%。患者前足底疼痛均有明显好转,4足有不同程度的第一跖趾关节疼痛,1足足中部不适,取内固定后消失。结论第一跖楔关节融合治疗外翻合并第一跖楔关节不稳能很好地纠正足横弓的塌陷、第一跖骨内翻畸形,对恢复第一跖骨头的负重功能有较好的治疗效果。采用钢板内固定能有效提高融合部位的稳定,利于前足的早期负重。     

半腱肌重建膝关节内侧副韧带和前交叉韧带的疗效分析

我们应用关节镜下重建前交叉韧带的同时辅助切口，采用半腱肌移位动力性重建内侧副韧带14例，随访显示效果良好。