Scarf联合改良Mcbride截骨术治疗中重度拇外翻疗效分析

目的 探讨Scarf联合改良Mcbride截骨术治疗中重度拇外翻的手术技巧及疗效.方法 选择陆军军医大学西南医院2014年7月至2015年6月采用Scarf联合改良Mcbride截骨术治疗的中重度拇外翻患者38例(47足),获得随访31例(38足).对趾骨近端关节固定角(PAA)增大患者加用拇趾近节趾骨Akin截骨,对第2、3跖骨头转移痛患者,行第2、3跖骨Weil截骨.通过手术前后足站立位、前后位及侧位X线片比较拇外翻角(HVA),第1、2跖骨间角(IMA),跖骨远端关节固定角(DMAA)、PAA等,采用美国足踝外科协会(AOFAS)评分系统进行疗效评估.结果 随访时间12～18个月,平均16.42个月.HVA由术前(41.82±5.28)°降至术后(17.03±4.04)°,IMA由术前(19.00±3.78)°降至术后(9.24±1.98)°.DMAA由术前(19.42±5.65)°降至术后(8.71±2.74)°,PAA由术前(5.66±3.27)°降至术后(3.82±2.09)°,AOFAS评分从术前(41.47±6.29)分上升为(84.82±6.43)分,差异均有统计学意义(P＜0.05).结论 Scarf联合改良Mcbride截骨术治疗中重度拇外翻具有满意的疗效.

Analysis on effect of Scarf combined with Mcbride osteotomy for treatment of moderate to severe hallux valgus

Objective To explore the surgical skill and curative effect of Scarf combined with modified Mcbride osteotomy for treating moderate to severe hallux valgus.Methods Thirty-eight patients (47 feet) with moderate to severe hallux valgus in the Southwest Hospital of Army Military Medical University from July 2014 to June 2015 were selected and treated by Scarf combined with modified Mcbride osteotomy,among them,31 cases(38 feet) were followed up.The cases of phalanx proximal articular angle(PAA) enlargement were added with Akin osteotomy hallex proximal phalanx,and 2,3 plantar Weil osteotomy was used in the patients with 2,3 plantar bone metastasis pain.The hallux valgus angle (HVA),1,2 intermetatarsal angle (IMA),distal metatarsal joint fixed angle(DMAA),PAA were compared between before and after surgery by the erect position,anteroposterior position and lateral X-ray films.The therapeutic effects were assessed by adopting the American Orthopedic Foot and Ankle Society(AOFAS) scoring system.Results The follow-up time was 12～18 months(average 16.42 months).HVA was decreased from preoperative(41.82±5.28)° to postoperative(17.03±4.04)°,IMA was decreased from preoperative(19.00 ± 3.78)°to postoperative(9.24 ± 1.98)°,DMAA was decreased from preoperative(19.42±5.65)°to postoperative(8.71±2.74)°,PAA was decreased from preoperative (5.66± 3.27) ° to postoperative (3.82 ± 2.09) °,and AOFAS score was increased from preoperative (41.47 ± 6.29) to postoperative (84.82 ± 6.43),the differences were statistically significant (P＜0.05).Conclusion Scarf combined with modified Mcbride osteotomy has satisfactory effect for treating moderate to severe hallux valgus.