Ludloff截骨修复矫治拇外翻的三维力学特点

背景：目前针对Ludloff截骨三维特点的研究甚少,且结论稍有不同,导致不能准确地理解其截骨特点。目的：分析Ludloff截骨技术修复矫治拇外翻的三维力学特点。方法：采用长86.56mm、直径30.65mm的木质圆柱体,进行Ludloff截骨矫治拇外翻的模拟试验,测量并记录数据。结果与结论：圆柱体的长度随矫形程度的增加而逐渐短缩;无论截骨面偏向跖侧、背侧或水平,截骨的结果均导致远端内旋。Ludolff截骨矫治拇外翻的结果是使截骨远端呈内旋,这对改善第一跖趾关节生物力学有积极的作用。对于有明显跖骨痛的患者可采用偏向跖侧15°～20°的截骨面;对于Ⅰ/ⅡIMA（≥30°）的患者,应谨慎使用Ludolff截骨。     

微创第1跖骨远端截骨技术治疗轻中度拇外翻临床观察

<正>拇外翻是前足部最常见的畸形,其病理改变包括:第1跖骨内收,拇趾外翻、旋前,第1跖趾关节外侧关节囊挛缩,第1跖骨头内侧出现骨赘、进而出现拇囊炎[1-2]。对于局部疼痛长期保守治疗效果差的患者,往往需要手术治疗。一般认为,第1跖骨远端截骨技术对于轻、中度拇外翻,且第1、2跖骨间角不超过20°的病例具有较好的治疗效果,并可以明显改善增大的近端     

改良McBride手术治疗足拇外翻

目的探讨改良McBride手术治疗足拇外翻畸形的方法及疗效。方法在McBride矫形术的基础上，笔者采用拇内收肌切断后缝合在拇指关节囊内侧中部，保留腓侧籽骨；术后包扎时用绷带从第1、2趾蹼间通过做“8”字形包扎，将拇趾固定在内翻位约5°～10°。结果参照美国足踝外科协会拇趾-跖趾-趾间关节评分系统评估，优24足，良9足，可2足，优良率94．2％；本组病例患者无一例发生拇外翻复发。结论改良McBride手术宜选择中度拇外翻，未出现跖趾关节骨性关节炎的患者，它不做截骨，愈合快，可较快恢复功能。     

改良Ludloff截骨法治疗足拇外翻畸形48例体会

目的探讨改良Ludloff截骨法治疗足拇外翻畸形的临床效果。方法对2001年到2008年这期间我科所采取的改良Ludloff截骨法手术治疗的方式的足拇外翻畸形患者共32例48足的资料进行的回顾性剖析。结果将畸形进行矫正好后,并没有发现什么不舒服的地方,能够充分地回到以往的工作以及生活当中21例33足;将畸形矫正好后,当足部行走的时候依旧会有疼痛的现象发生,然而,相比手术之前有着较为显著的效果2例4足。但是也存在着1例1足的手术后复发的例子,经保守治疗后症状缓解。结论使得第一跖骨及足拇趾在向外移位的同时亦有向跖侧的移位,使得足纵弓及横弓下塌得以改善,为足部功能的恢复创造了条件。     

改良Chevron截骨术治疗拇外翻畸形

目的：探索一种治疗中轻度拇外翻效果满意的术式。方法：对15例（21足）轻中度拇外翻畸形患者施行第一跖骨远端改良Chevron截骨拇术，采用美国足踝外科协会Maryland评分标准对疗效进行评定，结果术后无不愈合或延迟愈合、无感染。Maryland拇指关节评分90～100分者16足（76％）80～89分者4足（19％）70-79分者1足（5％）结论：该截骨术传统Chevron截骨术比较具有三维调节截骨远端的能力，截骨部骨接触面积大、嵌合固定好的特点。微弧形克氏针锁扣固定牢靠、操作简单、拔钉容易。对于轻中度有症状的拇外翻畸形是一种较为理想的治疗方法．     

迷你双螺纹空心钉结合截骨治疗拇外翻

背景：拇外翻畸形矫正方式多样,采用迷你双螺纹空心钉材料结合截骨矫形的方式损伤小,能够满足拇外翻矫形的目的,是临床上新型的微创生物型内固定材料。目的：回顾性分析迷你双螺纹空心钉材料应用于截骨矫形拇外翻治疗中的临床疗效。方法：选择拇外翻畸形患者30例,其中双侧矫形患者8例,单侧矫形患者22例。根据自愿均采用第一跖骨截骨矫形迷你双螺纹空心钉内固定,治疗前后拍摄X射线片测量外翻角、跖间角、籽骨位置,进行AOFAS评分,并计算第一跖骨短缩长度。结果与结论：采用迷你双螺纹空心钉结合截骨矫形治疗后,拇外翻畸形患者的外翻角、跖间角、AOFAS评分及籽骨位置较治疗前明显改善,第一跖骨短缩在矫形可控范围内避免畸形复发及跖骨痛。     

关于人工膝关节置换截骨中力学因素方面的临床问答

1 在人工全膝关节置换中,轴向力线和旋转力线确定的正确与否对假体置入的影响? 人工全膝关节关节置换手术中,共有6次截骨:股骨侧5次,胫骨侧1次.它们依次为股骨远端截骨(额状面外翻截骨);股骨外旋截骨(股骨前后方冠状面截骨);股骨前后斜面截骨以及胫骨近端(额状面)截骨.股骨外翻截骨和胫骨近端截骨确定了膝关节的轴向力线,股骨外旋截骨决定了股骨假体旋转力线.确定正确的轴向和旋转力线,是为了恢复膝关节行走时的正常应力分布.下肢轴向力线改变5°,就将导致膝关节承重改变40%.轴向力线不良,会造成髌骨轨迹不良,易发生髌前痛和髌骨脱位.     

Ludloff截骨术与Cheveron截骨术治疗足拇外翻的疗效对比

目的对比Ludloff截骨术与Cheveron截骨术治疗足拇外翻(HV)的疗效。方法选取我院2017年1月~2020年6月收治的80例HV患者,将实施Cheveron截骨术治疗的患者归为观察组(41例,45足),将实施Ludloff截骨术治疗的患者归为对照组(39例,43足)。对比两组术前、术后3个月足踝功能、影像学指标。结果术后3个月,两组美国足踝评分系统(AOFAS)各项评分均上升,拇外翻角(HVA)、第Ⅰ、Ⅱ跖骨间角(IMA)、第1跖骨远关节面角(DMAA)均下降,且观察组显著优于对照组,差异有统计学意义(P<0.05)。结论采用Cheveron截骨术治疗HV效果优于Ludloff截骨术,可改善患者足踝功能与HVA、IMA、DMAA角,促进其康复。     

拇外翻主要病理改变及组织修复方法的选择

拇外翻其病理改变具有多样性的,包括第一跖骨内收、第一,二跖骨问角增大、拇趾外翻角增大、第一跖趾关节近端关节面固定角或远端关节面固定角增大、籽骨移位、软组织平衡的改变等.X射线测量是确定拇外翻病理改变的主要的手段.拇外翻病理改变的多样性使得修复方式具有多样性,主要有软组织修复、截骨修复和关节融合或关节成形等修复方式.拇外翻修复方式的选择应该个体化,根据患者具体的病理改变选择一个或多个修复方式.     

可吸收螺钉在踇外翻第1跖骨远端改良chevron截骨中的应用

背景：第1跖骨远端改良chevron截骨是治疗踇外翻的常用术式,应用可吸收螺钉进行固定的效果尚存争议。目的：评价可吸收钉在踇外翻第1跖骨远端改良chevron截骨中的应用效果。方法：对8例中度踇外翻患者行远端改良chevron截骨,V形截骨后采用1枚2.7mm可吸收螺钉固定,穿前足免负重鞋6～8周。结果与结论：纳入的8例患者均获随访,随访时间28～46个月。患者伤口均一期愈合,踇外翻角改善为15°～21°,平均（17.63±2.07）°;第1,2跖骨间角为7°～9°,平均（8.00±0.76）°;美国足踝外科协会踇趾-跖趾-趾间关节评分由术前的（70.13±7.10）分提高到术后的（92.75±7.30）分（P〈0.05）。说明远端改良chevron截骨后使用可吸收螺钉固定治疗轻中度踇外翻疗效可靠,是一种有效的固定方法。     

Biomechanical comparison of screws and plates for hallux valgus opening-wedge and Ludloff osteotomies

BACKGROUND: The optimal osteotomy type and fixation method for hallux valgus correction have not been defined. This study examined the mechanical properties of corrective opening-wedge and Ludloff oblique osteotomies under conditions approximating postoperative weight-bearing. METHODS: Twenty-nine pairs of fresh-frozen metatarsals were divided into three groups. In Group 1, headless screws were compared with standard cortical screws for Ludloff osteotomy fixation. In Groups 2 and 3, Ludloff osteotomies fixed with headless screws were compared with opening-wedge osteotomies fixed with non-locking and locking plates, respectively. Constructs underwent dorsally-directed cantilever loading for 1000 cycles. FINDINGS: No significant differences in angulation or stiffness were demonstrable in Group 1. In Group 2, Ludloff/headless screw construct stiffness exceeded non-locking plate construct stiffness. The mean angulation on the 1000th load cycle was greater for plates than for Ludloff/headless screws. In Group 3, locking plate construct stiffness and angulation did not differ from Ludloff/headless screws in early cyclic loading, but fixation failure of the locking plate constructs was common. INTERPRETATION: The results indicate that screw type for Ludloff fixation may be left to surgeon preference and that opening-wedge plates exhibit mechanical properties inferior to that of the Ludloff osteotomy under the tested conditions. Lateral cortex continuity and bone density remain important factors in the performance of opening-wedge osteotomies.     

Biomechanical comparison of hallux valgus correction using the proximal chevron osteotomy fixed with a medial locking plate and the Ludloff osteotomy fixed with two screws

BackgroundFor moderate-to-severe hallux valgus deformities with a 1–2 intermetatarsal angle in excess of 15°, a proximal first metatarsal osteotomy is indicated. The ideal osteotomy has yet to be defined, but should inherently limit the incidence of dorsal malunion and allow for early ambulation. The present study evaluates the mechanical integrity of two popular first metatarsal osteotomies.MethodsTen matched pairs of fresh-frozen cadaveric first metatarsals were harvested. In one metatarsal from each pair, a Ludloff osteotomy was created and fixed with two cannulated 3.5 mm screws. In the contralateral first metatarsal, a proximal chevron osteotomy was performed and subsequently fixed with a medially applied locking plate. All specimens were mounted within an Instron 1321 servohydraulic materials testing machine and subjected to a plantar-to-dorsal cantilever bending protocol for 1000 cycles.FindingsTwo of ten Ludloff osteotomies failed prior to completion of 1000 loading cycles by fracture at the distal screw site, whereas six of ten proximal chevrons failed prior to the 1000th cycle. The mode of failure in this group was by cut-out of the plantar-proximal screw. The bending stiffness of the Ludloff osteotomy exceeded that of the proximal chevron at all measurement points between the 1st and 200th load cycles (P < 0.05). After 200 cycles, an inadequate number of plate constructs survived to allow statistical comparison.InterpretationThe results of the present study indicate that the proximal chevron osteotomy fixed with a medially based locking plate exhibits mechanical properties inferior to those of the Ludloff osteotomy under the tested conditions.     

Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study

BackgroundDeformity of the first ray in hallux valgus patient has been deemed to mainly contribute to instability of the metatarsophalangeal joint. However, it is not clear whether the fixation of the distal osteotomy fragment and transposition of the sesamoid represent the best method for hallux valgus treatment. The aim of this study was to examine how postoperative hallux valgus osteotomy affects the stability of the first ray.MethodsTo accurately investigate the biomechanical behavior of the first ray in pre-/postoperative hallux valgus patients, we described the relative displacement and stress distribution of the first metatarsal bone and sesamoid by imageology, test measurement and foot finite element model.FindingsCompared with the preoperative hallux valgus, the plantar pressure decreased by 47.8% and was redistributed on second metatarsal region. The peak stress and relative displacement of the distal osteotomy fragment increased by +55.7% and −59.9%, respectively. The movement of this component shifted toward the positive sagittal axis direction. In addition, the relative displacement of sesamoid decreased by 87.4% (0.18 mm) in vertical axis direction and the stress was also redistributed on medial and lateral region. Moreover, the strain of the medial main ligament was more favorable to reconstruct function of the first ray.InterpretationThe findings showed that the osteotomy method was helpful for stability of the first ray. This would provide the stability suggestions for postoperative hallux valgus fixation and guide further rehabilitation.     

Link动力加压钢支架治疗踇外翻

目的探讨link动力加压钢支架治疗踇外翻的效果及其适应证。方法采用改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻13例,对术后疼痛缓解程度,关节活动和外形改善进行比较。结果 13例手术优良率为100%,术后未出现并发症。结论改良chevron截骨术配合使用link动力加压钢支架治疗踇外翻效果良好。     

No Midterm Benefit from Low Intensity Pulsed Ultrasound after Chevron Osteotomy for Hallux Valgus

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity. (E-mail: max_zacherl@hotmail.com)     

第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻

目的探讨第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻的疗效。方法以江苏省人民医院2010年1月至2017年8月收治的80例拇外翻患者为对象,共131足。其中中重度拇外翻68足,对此68足拇外翻患者均予以第一跖骨基底部楔形截骨联合改良Mcbride手术治疗,分析疗效。结果随访时间均为术后1年,拇外翻角、第一与二跖骨夹角、第一跖骨远端关节面角均小于术前,差异有统计学意义(P均<0. 01);并发症发生率为3. 33%(2/68)。术后1年VAS疼痛评分(1. 68±0. 12)分,较术前的(6. 65±0. 31)分降低(P <0. 01),AOFAS评分(89. 54±2. 36)分,较术前的(42. 38±3. 42)分升高(P <0. 01)。结论第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻,可改善患者症状,且并发症少,可有效缓解患者疼痛、促进足部功能康复。     

The study of surface electromyography used for the assessment of abductor hallucis muscle activity in patients with hallux valgus

Background: Hallux valgus is a common foot disorder. In patients with hallux valgus, the anatomy and biomechanics of foot is subject to alterations. Objective: The aim of this clinical and neurophysiological study is to compare the activity of abductor hallucis (AbdH) muscle between the group of patients with hallux valgus and control group of healthy people, with the use of surface electromyography. Methods: The study involved 44 feet with diagnosed hallux valgus (research group) and 42 feet without deformation (control group). The X-ray images, measurements of range of motion in the first metatarsophalangeal joint and in hallux interphalangeal joint, and the surface electromyography study recorded from AbdH muscle were performed. Results: Considering the amplitude of motor unit action potential, study participants with hallux valgus demonstrate significantly less activity of AbdH muscle than people without hallux valgus deformity. This activity is not dependent on the severity of valgus, age, or range of motion. Conclusions: It is speculated that the changes of the AbdH function may occur in the period before clinical appearance of hallux valgus deformity, or at the onset of distortion development. Further studies are needed for a comprehensive assessment of AbdH muscle in patients with hallux valgus.