跖骨颈微创截骨结合中医正骨八法矫正拇外翻畸形

目的:探讨第一跖骨颈内侧截骨、术中配合正骨八法治疗脚拇趾外翻畸形的疗效。方法:2005年3月—2009年6月,采用跖骨颈微创截骨结合中医正骨八法治疗32例(46足)拇外翻患者,男9例,女23例,年龄35～79岁,平均55岁,病程6个月～10年,患者术前主要症状表现为拇外翻畸形、拇囊炎,穿鞋及行走时疼痛明显。手术前后均摄双足负重正侧位X线片,测量拇外翻角,第1、2跖骨间夹角及近侧关节固角以判定畸形程度,并采用足部疾患治疗效果AOFAS评分以评价其临床疗效。结果:随访时限为24～57个月,平均38个月。术后骨愈合满意,无延迟愈合及不愈合情况,术后足部持续疼痛2例。术后2年与术前相比,患者的拇外翻角,第1、2跖骨间夹角及近侧关节固角平均矫正11.7°、3.5°和9.7°,AOFAS评分提升33.8分。结论:跖骨微创截骨手术结合中医正骨八法是治疗拇趾外翻畸形的一种较好的、疗效可靠的手术方式。

The Minimally Invasive Osteotomy of First Metatarsal Neck with Traditional Chinese Orthopedics for the Treatment of Hallux Valgus(HV)

Objective:To investigate the effect of minimally invasive osteotomy of first metatarsal neck together with traditional Chinese orthopedics on hallux valgus(HV).Method:32 patients(46 feet) treated by minimally invasive osteotomy of first metatarsal neck together with traditional Chinese Orthopedics technique were reviewed.The follow-up survey period varied from 24 to 57 months with an average of 38 months.The major symptoms of pre-operative patient were hallux valgus,bunion and walking pain.Lateral and AP radiographs were taken in a standing position pre-and post operatively,on which hallux valgus angle(HVA),inter metatarsal angle(IMA)and proximal articular set angl(PASA)were measured.The efficacy of the surgery was evaluated by AOFAS scoring for foot disorders.Result:The fracture healing was excellent.There was no case of delay union and nonunion.Two cases were found to have continue pain.The mean corrections of HVA,IMA and PASA were 11.7°,3.5° and 9.7°.AOFAS score was elevated for 33.8 points.Conclusion:It is a good and reliable operation means for treatment Hallux valgus with minimally invasive osteotomy of first metatarsal neck together with Traditional Chinese Orthopedics.