改良Ludloff截骨术的几何形态学基础及其临床应用

目的 探讨Ludloff截骨术治疗母外翻后出现跖骨短缩、抬高及远端旋转的解决方案.方法 30例正常足,摄足部正侧位X线片,测量第一跖骨的长度及矢状面截骨角.计算在不同截骨条件下跖骨的抬高、短缩及旋前的理论值.根据该理论值,设计Ludloff截骨术的手术方案治疗??外翻.18例23足??外翻患者,如第一跖骨头内旋<3°,行单纯Ludloff截骨术;内旋角度为3°~6°,需行有冠状面截骨角的Ludloff截骨术;内旋角度>6°,行基底在外侧的楔形截骨;其中8足同时行第一跖骨远端截骨术以矫正跖骨远端关节角.采用??趾跖趾-趾间关节评分表及二至五趾跖趾-趾间关节评分表(AOFAS)进行疗效评定.结果 正常足第一跖骨的长度为4.60~6.90cm,平均(6.09±0.43)cm;矢状面截骨角为20.7°~31.3°,平均25.58°±2.73°.18例患者均获得随访,随访时间6~24个月,平均18个月.??趾跖趾-趾间关节评分:90~100分18足(78%),80~89分3足(13%),70~79分足2例(9%),评分平均增加36分(术前56分,术后92分);二至五趾跖趾-趾间关节评分:90~100分5足(22%),80~89分7足(30%),70~79分11足(48%),评分平均增加21分(术前59分,术后80分).结论 根据??外翻患者第一跖骨头不同的内旋角度,选取有冠状面截骨角或有基底在外侧的楔形截骨的Ludloff截骨术,可取得较理想的临床疗效.

The geometric problems of the Ludloff osteotomy using in hallux valgus

Objective To discuss the solutions to metatarsal shorting, elevation and distal rotation in Ludloff osteotomy for the treatment of hallux valgus. Methods The lengths, axial cut angle of the firs metatarsal were measured on AP and lateral radiographs of 30 normal feet. The theoretic value of the elevation, shorting and rotation of the first metatarsal head were calculated in various osteotomy. According to this value, the modified Ludloff osteotomy were devised. There were 18 cases, 23 feet of hallux valgus. If internal rotation of the first metatarsal head was less than 3°, only simple Ludloff osteotomy was enough. If the internal rotation is between 3°-6°, the Ludloff osteotomy was done with a coronal angle. If the internal rotation was more than 6°, the wedge osteotomy based on the lateral side was needed to add. The distal osteotomy were associated with Ludloff in 8 feet to correct the distal metatarsal articular angle. All patients were evaluated by the hallux MTP-IP scale and the lesser MTP-IP scale (AOFAS). Results The length of the firs metatarsal in normal feet was between 4.60 cm to 6.90cm, with the average of (6.09±0.43) cm. The axial cut angle was between 20.7° and 31.3°, the average was 25.58°±2.73°. 18 patients were followed for 6 to 24 months, 18 months in average. The AOFAS hallux MTP-IP score was 90-100 in 18 feet (78%), 80-89 in 3feet (13%), 70-79 in 2 feet (9%). The score was improved from 56 to 92 points, 36 in average. The AOFAS lesser MTP-IP score was 90-100 in 5 feet (22%), 80-89 in 7 feet (30%), 70-79 in 11 feet (48%). The score was improved from 59 to 80 points, 21 in average. Conclusion According to internal rotation angle of the first metatarsal head, more ideal clinical effective can be achieved by selecting the Ludloff osteotomy with a coronal cut angle or a lateral side based wedge osteotomy for the treatment of severe hallux valgus.